In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis

M D M Bolmers^{1

2}, J de Jonge³, W J Bom³, C C van Rossem⁴, A A W van Geloven³, W A Bemelman⁵; Snapshot Appendicitis Collaborative Study group

Collaborators, Affiliations

Collaborators

Snapshot Appendicitis Collaborative Study group:
G J Van Acker, B Akkermans, G J Akkersdijk, G D Algie, J H Allema, C S Andeweg, N Appeldoorn, J G van Baal, C M den Bakker, S A Bartels, C van den Berg, B Boekestijn, F C den Boer, D Boerma, A L van den Boom, M C Boute, S A Bouwense, J Bransen, F A van Brussel, O R Busch, S M de Castro, H A Cense, C Croese, T van Dalen, I Dawson, E van Dessel, R Dettmers, N Dhar, F Y Dohmen, K W van Dongen, P van Duijvendijk, R R Dulfer, B J Dwars, J P Eerenberg, M van der Elst, E van den Ende, L M Fassaert, J T Fikkers, J W Foppen, E J Furnee, F P Garssen, M F Gerhards, H van Goor, J S de Graaf, L J Graat, J Grootr, A C van der Ham, J F Hamming, J T Hamminga, E van der Harst, J Heemskerk, A Heijne, J T Heikens, E Heineman, R Hertogs, E van Heurn, L C van den Hil, A G Hooftwijk, C C Hulsker, D R Hunen, M S Ibelings, J M Klaase, R Klicks, L Knaapen, R T Kortekaas, F Kruyt, S Kwant, S S Lases, T Lettinga, A Loupatty, R A Matthijsen, R C Minnee, B Mirck, L Mitalas, D Moes, A M Moorman, V B Nieuwenhuijs, G A Nieuwenhuizen, P D Nijk, J M Omloo, A G Ottenhof, H W Palamba, D L van der Peet, I T Pereboom, P W Plaisier, A P van der Ploeg, M H Raber, M M Reijen, H Rijna, C Rosman, R M Roumen, R F Scmitz, A P Schouten van der Velden, W H Scheurs, T A Sigterman, H J Smeets, D J Sonnevled, M N Sosef, S F Spoor, L P Stassen, L van Steensel, E Stortelder, J Straatman, H J van Susante, D E Suykerbuyk de Hoog, C Terwisscha van Scheltinga, B R Toorenvliet, P C Verbeek, M Verseveld, J H Volders, M R Vriens, P W Vriens, B C Vrouenraets, B J van de Wall, J A Wegdam, E Westerduin, J J Wever, N A Wijfels, B P Wijnhoven, T A Winkel, D C van der Zee, A M Zeillemaker, C Zietse

Affiliations

¹ Department of Surgery, Dijklander Hospital, Hoorn, The Netherlands. mdmbolmers@gmail.com.
² Department of Surgery, Tergooi Hospital, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands. mdmbolmers@gmail.com.
³ Department of Surgery, Tergooi Hospital, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands.
⁴ Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
⁵ Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.

PMID: 35048258
DOI: 10.1007/s11605-021-05220-w

Multicenter Study

In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis

M D M Bolmers et al. J Gastrointest Surg. 2022 May.

. 2022 May;26(5):1063-1069.

doi: 10.1007/s11605-021-05220-w. Epub 2022 Jan 20.

Authors

M D M Bolmers^{1

2}, J de Jonge³, W J Bom³, C C van Rossem⁴, A A W van Geloven³, W A Bemelman⁵; Snapshot Appendicitis Collaborative Study group

Collaborators

Snapshot Appendicitis Collaborative Study group:
G J Van Acker, B Akkermans, G J Akkersdijk, G D Algie, J H Allema, C S Andeweg, N Appeldoorn, J G van Baal, C M den Bakker, S A Bartels, C van den Berg, B Boekestijn, F C den Boer, D Boerma, A L van den Boom, M C Boute, S A Bouwense, J Bransen, F A van Brussel, O R Busch, S M de Castro, H A Cense, C Croese, T van Dalen, I Dawson, E van Dessel, R Dettmers, N Dhar, F Y Dohmen, K W van Dongen, P van Duijvendijk, R R Dulfer, B J Dwars, J P Eerenberg, M van der Elst, E van den Ende, L M Fassaert, J T Fikkers, J W Foppen, E J Furnee, F P Garssen, M F Gerhards, H van Goor, J S de Graaf, L J Graat, J Grootr, A C van der Ham, J F Hamming, J T Hamminga, E van der Harst, J Heemskerk, A Heijne, J T Heikens, E Heineman, R Hertogs, E van Heurn, L C van den Hil, A G Hooftwijk, C C Hulsker, D R Hunen, M S Ibelings, J M Klaase, R Klicks, L Knaapen, R T Kortekaas, F Kruyt, S Kwant, S S Lases, T Lettinga, A Loupatty, R A Matthijsen, R C Minnee, B Mirck, L Mitalas, D Moes, A M Moorman, V B Nieuwenhuijs, G A Nieuwenhuizen, P D Nijk, J M Omloo, A G Ottenhof, H W Palamba, D L van der Peet, I T Pereboom, P W Plaisier, A P van der Ploeg, M H Raber, M M Reijen, H Rijna, C Rosman, R M Roumen, R F Scmitz, A P Schouten van der Velden, W H Scheurs, T A Sigterman, H J Smeets, D J Sonnevled, M N Sosef, S F Spoor, L P Stassen, L van Steensel, E Stortelder, J Straatman, H J van Susante, D E Suykerbuyk de Hoog, C Terwisscha van Scheltinga, B R Toorenvliet, P C Verbeek, M Verseveld, J H Volders, M R Vriens, P W Vriens, B C Vrouenraets, B J van de Wall, J A Wegdam, E Westerduin, J J Wever, N A Wijfels, B P Wijnhoven, T A Winkel, D C van der Zee, A M Zeillemaker, C Zietse

Affiliations

¹ Department of Surgery, Dijklander Hospital, Hoorn, The Netherlands. mdmbolmers@gmail.com.
² Department of Surgery, Tergooi Hospital, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands. mdmbolmers@gmail.com.
³ Department of Surgery, Tergooi Hospital, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands.
⁴ Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
⁵ Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.

PMID: 35048258
DOI: 10.1007/s11605-021-05220-w

Abstract

Background: Present theory is that uncomplicated and complicated appendicitis are different entities. Recent studies suggest it is safe to delay surgery in patients with uncomplicated appendicitis. We hypothesize that patients with complicated appendicitis are at higher risk for postoperative complications when surgery is delayed.

Methods: Data was used from the multicenter, prospective SNAPSHOT appendicitis study of 1975 patients undergoing surgery for suspected appendicitis. Adult patients (≥ 18 years) who underwent appendectomy for appendicitis were included in this study. The primary outcome was the difference in postoperative complications between patients with complicated appendicitis who were operated within and after 8 h after hospital presentation. Secondary outcomes were the incidence of both uncomplicated and complicated appendicitis in relationship to delay of appendectomy. Follow-up was 30 days. A multivariable analysis was performed.

Results: Of 1341 adult patients with appendicitis, 34.3% had complicated appendicitis. In patients with complicated appendicitis, 22.8% developed a postoperative complication compared to 8.2% for uncomplicated appendicitis (P < 0.001). Delay in surgery (> 8 h) increased the complication rate in patients with complicated appendicitis (28.1%) compared to surgery within 8 h (18.3%; P = 0.01). Multivariate analysis showed a delay in surgery as an independent predictor for a postoperative complication in patients with complicated appendicitis (OR 1.71; 95%CI 1.01-2.68, P = 0.02).

Conclusion: In-hospital delay of surgery (> 8 h) in patients with complicated appendicitis is associated with a higher risk of a postoperative complication. It is important that we recognize and treat these patients early.

Keywords: Appendicitis; Complicated; Delay in surgery.

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References

1. Wagner M, Tubre DJ, Asensio JA. Evolution and Current Trends in the Management of Acute Appendicitis. The Surgical clinics of North America. 2018;98(5):1005-1023. - DOI
1. Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Annals of surgery. 2007;245(6):886-892. - DOI
1. Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg. 2007;31(1):86-92. - DOI
1. Rubér M, Andersson M, Petersson BF, Olaison G, Andersson RE, Ekerfelt C. Systemic Th17-like cytokine pattern in gangrenous appendicitis but not in phlegmonous appendicitis. Surgery. 2010;147(3):366-372. - DOI
1. Styrud J, Eriksson S, Nilsson I, et al. Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial. World J Surg. 2006;30(6):1033–1037.

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In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis

Collaborators

Affiliations

In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis

Authors

Collaborators

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical