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Delaying surgery in adults with acute appendicitis does not appear to adversely affect 30-day outcomes, a study published in the September issue of the Archives of Surgery has shown.
“Because of potentially limited physical and professional staffing, an acute care surgeon may need to delay the operation of less critically ill patients to appropriately care for those requiring immediate attention. Our research demonstrates that the frequent, though previously minimally researched, practice of nonimmediate operative treatment of adult patients with acute appendicitis does not appear to significantly affect patient outcomes,” said Dr. Angela M. Ingraham of the University of Cincinnati and her associates.
They used data from the American College of Surgeons National Surgical Quality Improvement Program to examine 30-day morbidity and mortality outcomes in 32,782 patients treated for acute appendicitis between 2005 and 2009. In 75% of these cases, surgery was begun within 6 hours of admission. However, in 15% surgery was delayed for 6-12 hours, and in 10% it was delayed for more than 12 hours.
The patients, aged 16 and older, had either simple appendicitis (83%) or complicated appendicitis (17%). Seventy-six percent of the operations were laparoscopic and 24% were open.
Delaying the start of surgery, even for more than 12 hours, “[did] not represent a clinically significant burden,” wrote the investigators. After the data were adjusted to account for baseline differences in disease severity, there were no significant differences in overall morbidity or in serious morbidity/mortality across the three time intervals, said Dr. Ingraham, who is also in the division of research and optimal patient care, American College of Surgeons, and her colleagues.
Overall morbidity was 5.6% when appendectomy was performed within 6 hours, 5.6% when it was performed at 6-12 hours, and 6.0% when it was performed 12 hours or more after admission – differences that are not clinically significant. The corresponding rates of the composite outcome of serious morbidity and mortality were 3.0%, 3.1%, and 3.5%, respectively. These differences also are not clinically significant.
The overall length of stay (from surgical admission to discharge) was statistically significantly different among the three groups (1.8 days, 2.0 days, and 3.1 days, respectively), as was the length of postoperative stay (2.2 days for those whose surgery was performed 12 hours or more after admission vs. 1.8 days for the remaining two groups), although the latter was not clinically significant, according to the investigators.
Recent advances in imaging technology and antibiotic therapy have permitted better preoperative assessment and treatment, “allowing for nonoperative management of abscesses and phlegmons, and potentially limiting the need for immediate operative intervention to halt disease progression,” the investigators noted (Arch. Surg. 2010;145:886-92).
They acknowledged some limitations to the study, including the fact that “parity may have been influenced by differences in patient or organizational factors or by clinical interventions” unknown to the authors, but they added that their findings agree with those of “several other studies in the adult and pediatric literature that have found no increased rates of complications among patients who had a delay to appendectomy.”
Dr. Ingraham’s study received no industry support. The study investigators reported no financial disclosures.
The most important point of Dr. Ingraham’s study is that it validates the widespread practice of treating acute appendicitis urgently rather than emergently, said Dr. John G. Hunter.
“These data provide the justification for performing appendectomy as soon as is convenient” – which in many cases means the next morning rather than in the middle of the night. This allows the surgeon to face not just that appendectomy but the entire next day’s procedures without unnecessary fatigue.
“A secondary benefit is the savings to the hospital generated by minimizing staff and anesthesiologist presence late in the evening and during the wee hours of the morning,” he added.
“Financial savings without any evidence of adversity to the patient and the promise of a well-rested surgeon in the morning provide benefit sufficiently ample for me to embrace these recommendations. At the end of the day, it is clearly a win-win-win situation when the interests of the patient, the surgeon, and the hospital are in complete alignment around such a shift in surgical practice.”
Dr. Hunter is a surgeon at Oregon Health and Science University, Portland. He reported no financial disclosures. These comments are taken from his Invited Critique that accompanied Dr. Ingraham’s report (Arch. Surg. 2010;145:892).
The most important point of Dr. Ingraham’s study is that it validates the widespread practice of treating acute appendicitis urgently rather than emergently, said Dr. John G. Hunter.
“These data provide the justification for performing appendectomy as soon as is convenient” – which in many cases means the next morning rather than in the middle of the night. This allows the surgeon to face not just that appendectomy but the entire next day’s procedures without unnecessary fatigue.
“A secondary benefit is the savings to the hospital generated by minimizing staff and anesthesiologist presence late in the evening and during the wee hours of the morning,” he added.
“Financial savings without any evidence of adversity to the patient and the promise of a well-rested surgeon in the morning provide benefit sufficiently ample for me to embrace these recommendations. At the end of the day, it is clearly a win-win-win situation when the interests of the patient, the surgeon, and the hospital are in complete alignment around such a shift in surgical practice.”
Dr. Hunter is a surgeon at Oregon Health and Science University, Portland. He reported no financial disclosures. These comments are taken from his Invited Critique that accompanied Dr. Ingraham’s report (Arch. Surg. 2010;145:892).
The most important point of Dr. Ingraham’s study is that it validates the widespread practice of treating acute appendicitis urgently rather than emergently, said Dr. John G. Hunter.
“These data provide the justification for performing appendectomy as soon as is convenient” – which in many cases means the next morning rather than in the middle of the night. This allows the surgeon to face not just that appendectomy but the entire next day’s procedures without unnecessary fatigue.
“A secondary benefit is the savings to the hospital generated by minimizing staff and anesthesiologist presence late in the evening and during the wee hours of the morning,” he added.
“Financial savings without any evidence of adversity to the patient and the promise of a well-rested surgeon in the morning provide benefit sufficiently ample for me to embrace these recommendations. At the end of the day, it is clearly a win-win-win situation when the interests of the patient, the surgeon, and the hospital are in complete alignment around such a shift in surgical practice.”
Dr. Hunter is a surgeon at Oregon Health and Science University, Portland. He reported no financial disclosures. These comments are taken from his Invited Critique that accompanied Dr. Ingraham’s report (Arch. Surg. 2010;145:892).
Delaying surgery in adults with acute appendicitis does not appear to adversely affect 30-day outcomes, a study published in the September issue of the Archives of Surgery has shown.
“Because of potentially limited physical and professional staffing, an acute care surgeon may need to delay the operation of less critically ill patients to appropriately care for those requiring immediate attention. Our research demonstrates that the frequent, though previously minimally researched, practice of nonimmediate operative treatment of adult patients with acute appendicitis does not appear to significantly affect patient outcomes,” said Dr. Angela M. Ingraham of the University of Cincinnati and her associates.
They used data from the American College of Surgeons National Surgical Quality Improvement Program to examine 30-day morbidity and mortality outcomes in 32,782 patients treated for acute appendicitis between 2005 and 2009. In 75% of these cases, surgery was begun within 6 hours of admission. However, in 15% surgery was delayed for 6-12 hours, and in 10% it was delayed for more than 12 hours.
The patients, aged 16 and older, had either simple appendicitis (83%) or complicated appendicitis (17%). Seventy-six percent of the operations were laparoscopic and 24% were open.
Delaying the start of surgery, even for more than 12 hours, “[did] not represent a clinically significant burden,” wrote the investigators. After the data were adjusted to account for baseline differences in disease severity, there were no significant differences in overall morbidity or in serious morbidity/mortality across the three time intervals, said Dr. Ingraham, who is also in the division of research and optimal patient care, American College of Surgeons, and her colleagues.
Overall morbidity was 5.6% when appendectomy was performed within 6 hours, 5.6% when it was performed at 6-12 hours, and 6.0% when it was performed 12 hours or more after admission – differences that are not clinically significant. The corresponding rates of the composite outcome of serious morbidity and mortality were 3.0%, 3.1%, and 3.5%, respectively. These differences also are not clinically significant.
The overall length of stay (from surgical admission to discharge) was statistically significantly different among the three groups (1.8 days, 2.0 days, and 3.1 days, respectively), as was the length of postoperative stay (2.2 days for those whose surgery was performed 12 hours or more after admission vs. 1.8 days for the remaining two groups), although the latter was not clinically significant, according to the investigators.
Recent advances in imaging technology and antibiotic therapy have permitted better preoperative assessment and treatment, “allowing for nonoperative management of abscesses and phlegmons, and potentially limiting the need for immediate operative intervention to halt disease progression,” the investigators noted (Arch. Surg. 2010;145:886-92).
They acknowledged some limitations to the study, including the fact that “parity may have been influenced by differences in patient or organizational factors or by clinical interventions” unknown to the authors, but they added that their findings agree with those of “several other studies in the adult and pediatric literature that have found no increased rates of complications among patients who had a delay to appendectomy.”
Dr. Ingraham’s study received no industry support. The study investigators reported no financial disclosures.
Delaying surgery in adults with acute appendicitis does not appear to adversely affect 30-day outcomes, a study published in the September issue of the Archives of Surgery has shown.
“Because of potentially limited physical and professional staffing, an acute care surgeon may need to delay the operation of less critically ill patients to appropriately care for those requiring immediate attention. Our research demonstrates that the frequent, though previously minimally researched, practice of nonimmediate operative treatment of adult patients with acute appendicitis does not appear to significantly affect patient outcomes,” said Dr. Angela M. Ingraham of the University of Cincinnati and her associates.
They used data from the American College of Surgeons National Surgical Quality Improvement Program to examine 30-day morbidity and mortality outcomes in 32,782 patients treated for acute appendicitis between 2005 and 2009. In 75% of these cases, surgery was begun within 6 hours of admission. However, in 15% surgery was delayed for 6-12 hours, and in 10% it was delayed for more than 12 hours.
The patients, aged 16 and older, had either simple appendicitis (83%) or complicated appendicitis (17%). Seventy-six percent of the operations were laparoscopic and 24% were open.
Delaying the start of surgery, even for more than 12 hours, “[did] not represent a clinically significant burden,” wrote the investigators. After the data were adjusted to account for baseline differences in disease severity, there were no significant differences in overall morbidity or in serious morbidity/mortality across the three time intervals, said Dr. Ingraham, who is also in the division of research and optimal patient care, American College of Surgeons, and her colleagues.
Overall morbidity was 5.6% when appendectomy was performed within 6 hours, 5.6% when it was performed at 6-12 hours, and 6.0% when it was performed 12 hours or more after admission – differences that are not clinically significant. The corresponding rates of the composite outcome of serious morbidity and mortality were 3.0%, 3.1%, and 3.5%, respectively. These differences also are not clinically significant.
The overall length of stay (from surgical admission to discharge) was statistically significantly different among the three groups (1.8 days, 2.0 days, and 3.1 days, respectively), as was the length of postoperative stay (2.2 days for those whose surgery was performed 12 hours or more after admission vs. 1.8 days for the remaining two groups), although the latter was not clinically significant, according to the investigators.
Recent advances in imaging technology and antibiotic therapy have permitted better preoperative assessment and treatment, “allowing for nonoperative management of abscesses and phlegmons, and potentially limiting the need for immediate operative intervention to halt disease progression,” the investigators noted (Arch. Surg. 2010;145:886-92).
They acknowledged some limitations to the study, including the fact that “parity may have been influenced by differences in patient or organizational factors or by clinical interventions” unknown to the authors, but they added that their findings agree with those of “several other studies in the adult and pediatric literature that have found no increased rates of complications among patients who had a delay to appendectomy.”
Dr. Ingraham’s study received no industry support. The study investigators reported no financial disclosures.