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Recent literature suggests that delaying appendectomy until daytime surgery is available is safe in children who present with appendicitis. These authors addressed the safety of delaying appendectomy in adults.
They reviewed charts of 1081 adult patients who underwent appendectomy for acute appendicitis from 1998 to 2004 to determine time from symptom onset to emergency department arrival (patient interval), time from ED admission to surgery (hospital interval), and grade of appendiceal pathology. The authors found that a longer total time from symptom onset to surgery increased the risk for advanced pathology and complications, such as perforation, phlegmon, abscess, and gangrenous appendicitis. For example, the risk for advanced pathology was 13 times greater when the interval was greater than 71 hours than when the interval was less than 12 hours. Delays in the patient interval were more strongly associated with complications than were delays in the hospital interval.
Ditillo MF et al. Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg 2006 Nov; 244:656-60.
Comment
This study, one of the largest to date to address the timing of appendectomy in adults, shows that delays to surgery can have significant consequences. Delays attributable to patients were most strongly associated with complications, but little can be done to prevent such delays. Providing expeditious evaluation and surgery, however, is under our control. Although performing surgery in the “off hours” is inconvenient, putting the patient first is paramount when delay might cause harm, as appears to be the case in adults with appendicitis.