In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis

• DOI: 10.1007/s11605-021-05220-w
• Publication Date: 2022-01-20T00:04:11Z
• Authors: M.D.M. Bolmers; J. de Jonge; W.J. Bom; C.C. van Rossem; A.A.W. van Geloven; W.A. Bemelman; 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...; 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 d...; C. Terwisscha van...; 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
• Keywords: Adult; Length of Stay; Radboudumc 14: Tumours of the digestive tract RIHS: Radboud Institute for Health Sciences; Appendicitis; Hospitals; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Acute Disease; Appendectomy; Humans; Laparoscopy; Prospective Studies; Retrospective Studies

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.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.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).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.