Omundsen Mark, Dennett Elisabeth
Department of Surgery, Wellington Hospital, Wellington, New Zealand.
ANZ J Surg. 2006 Mar;76(3):153-5. doi: 10.1111/j.1445-2197.2006.03673.x.
This retrospective review was undertaken to determine if time between presentation and appendicectomy is a factor affecting morbidity and length of hospital stay for patients with proven appendicitis.
The notes of patients who underwent an appendicectomy at Wellington Public Hospital, New Zealand between June 2002 and February 2004 were retrospectively reviewed. Delay from admission until surgery was noted. Other variables recorded were age, sex, operation type (laparoscopic or open), white cell count, pulse rate and temperature at admission, antibiotic usage, ancillary investigations (e.g. ultrasound), operative findings, length of admission and in-hospital complications.
A total of 480 appendicectomies were carried out. Four hundred and fifty-seven (95%) records were retrieved, and 436 (91%) included the required information and were analysed. Ninety-one (21%) resected appendices were pathologically normal, 275 (63%) were nonperforated, 61 (14%) were perforated and 9 (2%) had appendicular abscesses. The mean waiting time from admission to operation was 14.5 h (range, 1.6-99 h). There were 36 complications in 31 (7%) patients. The mean hospital stay was 74.4 h (range, 9.2-372 h). Three hundred and forty-five admitted patients had histologically proven appendicitis. Patients who waited 12-24 h for their surgery, when compared with those that waited less than 12 h, did not have a statistically significant difference in either perforation rates (P = 0.66) or abscess formation (P = 0.14). There was also no statistically significant difference in the postoperative length of hospital stay (P = 0.6) or complication rate (P = 0.92) in patients who waited >24 h for their surgery. Patients with appendicitis who waited for >24 h (n = 44) had more abscesses (P = 0.0001). There was also a statistically significant difference in the perforation rate (P = 0.0001), postoperative length of stay (P = 0.04) and overall complication rate (P = 0.01).
Time to surgery of up to 24 h does not lead to an increase in complicated appendicitis or morbidity. When the time exceeds 24 h, there is an increased rate of complicated appendicitis and morbidity, including complications that are not directly related to the appendicitis.
进行这项回顾性研究以确定从就诊到阑尾切除的时间是否是影响确诊阑尾炎患者发病率和住院时间的一个因素。
对2002年6月至2004年2月在新西兰惠灵顿公立医院接受阑尾切除术的患者病历进行回顾性研究。记录从入院到手术的延迟时间。记录的其他变量包括年龄、性别、手术类型（腹腔镜或开放手术）、入院时的白细胞计数、脉搏率和体温、抗生素使用情况、辅助检查（如超声）、手术结果、住院时间和院内并发症。
共进行了480例阑尾切除术。检索到457份（95%）病历，其中436份（91%）包含所需信息并进行分析。91份（21%）切除的阑尾病理检查正常，275份（63%）未穿孔，61份（14%）穿孔，9份（2%）有阑尾脓肿。从入院到手术的平均等待时间为14.5小时（范围1.6 - 99小时）。31例（7%）患者出现36例并发症。平均住院时间为74.4小时（范围9.2 - 372小时）。345例入院患者经组织学证实为阑尾炎。等待12 - 24小时进行手术的患者与等待时间少于12小时的患者相比，穿孔率（P = 0.66）或脓肿形成率（P = 0.14）无统计学显著差异。等待手术超过24小时的患者术后住院时间（P = 0.6）或并发症发生率（P = 0.92）也无统计学显著差异。等待超过24小时的阑尾炎患者（n = 44）有更多脓肿（P = 0.0001）。穿孔率（P = 0.0001）、术后住院时间（P = 0.04）和总体并发症发生率（P = 0.01）也有统计学显著差异。
手术时间长达24小时不会导致复杂性阑尾炎或发病率增加。当时间超过24小时时，复杂性阑尾炎和发病率增加，包括与阑尾炎无直接关系的并发症。
