Abstract

Introduction: Acute appendicitis is one of the most common acute conditions that needs an emergency surgical intervention. It is widely acceptable that delay in diagnosis and treatment significantly contribute to increased incidences of perforated appendicitis, which eventually results in increased chances of patient morbidity. It has accepted generally that an appendectomy should be performed within a few hours of diagnosis and that a delay in the operation may lead to a greater incidence in the morbidity.
Methodology: In this study, we took an effort to assess whether appendectomy for acute appendicitis can be safely delayed for 72 hours after the initial diagnosis in our hospital. We included patients who underwent appendectomies after a preoperative diagnosis of acute appendicitis that was confirmed after pathological examination. There are some patients who were younger than 15 years, patients who underwent negative appendectomies, incidental appendectomies, or interval appendectomies were excluded from the study. Patients who were included in the study were divided into 2 groups mainly. The early group comprised patients who underwent appendectomies within 72 hours after presentation to the emergency department. The late group comprised patients who underwent appendectomies 72 hours after presentation. There were several reasons for the delay in the operation: the time between admission to the emergency department and surgical consultation, the lack of operating room availability, a delay in the diagnosis owing to an atypical presentation, and the surgeon’s decision to delay the surgical procedure. Oral intake was stopped for patients in both groups for the preparation of surgical intervention. The t - test and Fisher exact test were used to analyse the statistical difference between these 2 groups. We calculated a sample size of 152 patients in each group to detect an increase of 10% in the rate of advanced appendicitis, with a power of 80%.4 A P value of <0.05 was considered statistically significant.
Results: Three hundred and eleven patients were included in the study. Out of which were 166 men and 145 women. The average age was calculated to be 28 years (age range, 15-40 years). There were 233 patients in the early group and 76 patients in the late group. The mean ± SD time between presenting to the emergency department and surgery was 6.7±2.7 hours for the early group and 16.7±3.6 hours for the late group. Both groups were comparable with respect to age, sex, white blood cell count, and temperature. There were no statistically significant differences between the 2 groups in the length of stay (P=0.17), average operative time (P=.93 for laparoscopic surgery; P=0.14 for open surgery), rate of advanced appendicitis (P=0.56), and complication rate (P=.74) (In comparing the time of presentation to the emergency department and the time of operation, 54% of patients were admitted to the emergency department during the day hours (7 AM–7 PM) vs 46% during the evening and night hours (7 PM–7 AM). This percentage was reversed slightly when observing the time of operation: 57% during the evening and night hours vs 43% during the day hours.
Conclusion: A successful approach in the treatment of acute appendicitis includes the early administration of intravenous antibiotics and fluid hydration followed by the appendectomy procedure during the day hours does not increase the rate of complications and it does not significantly increase the length of stay or rate of advanced appendicitis. In addition, this practice pattern decreases the need for operating during the late-night hours or the interruption of the regular operating room schedule. Finally, it aids in focusing resources and operating room availability to life-threatening emergencies.