Emergency General Surgery by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783319962863
Publisher: Springer International Publishing

Appendectomy Timing

Immediate appendectomy to prevent perforation has been challenged by recent studies supporting a semielective approach to acute appendicitis [30, 44–47]. However, increased morbidity associated with appendectomy delay has been reported [48–50]. Because of this potential morbidity risk associated with surgical delay, prompt surgical intervention remains the safest approach for patients with the diagnosis of acute appendicitis. In our own review of over 4000 patients undergoing appendectomy for acute appendicitis at an urban academic tertiary center, 64% of patients underwent appendectomy more than 6 h after admission (overall average time 11 h and 50 min). After adjusting for age, gender, leukocytosis, perforation, and laparoscopy, a delay greater than 6 h from surgical admission to appendectomy was independently associated with increased rates of surgical site infection. For the subgroup of patients without perforation, patients who underwent appendectomy within 6 h had a 42% relative risk reduction in surgical site infection rates. Those who developed an infection remained an additional 5 days in the hospital and the incurred costs associated with it [51].

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