|Author: Landisch RM et al., JAMA Pediatr 2017 Jun 19;
The time to appendectomy, if performed within 24 hours of presentation, was
not associated with perforation or other complications.
|Although studies are inconclusive, many physicians feel that a delay in
appendectomy may result in complications (perforation) and prolonged
hospital stay. Using the Pediatric National Surgical Quality Improvement
Program database, researchers examined time to appendectomy (TTA) and its
association with complications for 2429 children (age <18 years) who had
appendectomies within 24 hours of emergency department (ED) admission in
2013 and 2014. Patients who were evaluated and then referred and those who
had a computed tomography scan prior to appendectomy were excluded.
The median TTA (time from ED registration to skin incision) for all 23 hospitals
was 7.4 hours (range, 5.0 to 19.2 hours). Overall, 23.6% of patients had
complicated appendicitis. In multivariable analysis, increased risk for
complicated appendicitis was associated with age <7 years, female sex, and
Hispanic ethnicity. Longer TTA was not associated with increased risk for
complications or adverse postoperative events (e.g., surgical site infections).
However, the longer the TTA, the longer the length of stay, with each 1-hour
delay translating to a 1.4-hour longer stay. Within each hospital, a TTA longer
than that hospital’s median was not associated with adverse postoperative events.