Udgiri Navalkishor, Curras Ernesto, Kella Venkata K, Nagpal Kamal, Cosgrove John
Department of Surgery, Bronx Lebanon Hospital, Bronx, New York, USA.
Am Surg. 2011 Jul;77(7):898-901.
Prompt appendectomy has always been a standard of care because of the risk of progression in pathology. This time honored practice has been recently challenged by studies, suggesting that appendicitis can be operated on electively. The aim of this study is to examine whether delayed intervention in acute appendicitis is safe by correlating the interval from presentation to operation with the operative and postoperative complications. Retrospective review of patients who underwent appendectomy for acute appendicitis in 2009 was done. The following parameters were recorded: demographics, duration from presentation to evaluation by emergency room attending, performing CT scan, surgical consult, and operation. The pathology, post operative complications, and length of stay were also recorded. Patients were divided into two groups: incision time < 10 hours (early group) and incision time > 10 hours (delayed group). The end points chosen for comparison were: 1) laparoscopic to open conversion rate, 2) complications, 3) readmissions, and 4) length of stay. Number of cases totaled 201, with 76 in the < 10 hours group and 125 in the > 10 hours group. The male to female ratio for the < 10 hours group was 54:22 and for the > 10 hours group was 59:66 (P < 0.001). Length of stay for the early group was 75.52 hours and for the delayed group, 89.15 hours (P = 0.04). There was one intra-abdominal abscess in the early group and 10 in the delayed group (P = 0.04). The early group had 0.2 (2.6%) open conversions, and the delayed group had five (4.1%) conversions (P = 0.58). There were six (4.8%) readmissions in the delayed group and none in the early group (P = 0.05). Our study reveals that the complication rate, length of stay, and readmissions are more in the delayed group. Conversion rate was more in the delayed group, but the difference was not significant. We conclude that early surgical intervention is beneficial in acute appendicitis.
由于存在病理进展风险，急诊阑尾切除术一直是一种标准治疗方法。这项历史悠久的做法最近受到了一些研究的挑战，这些研究表明阑尾炎可以择期手术。本研究的目的是通过将从就诊到手术的时间间隔与手术及术后并发症相关联，来检验急性阑尾炎延迟干预是否安全。对2009年因急性阑尾炎接受阑尾切除术的患者进行了回顾性研究。记录了以下参数：人口统计学资料、从就诊到急诊室医生评估、进行CT扫描、外科会诊及手术的时长。还记录了病理情况、术后并发症及住院时间。患者被分为两组：手术时间<10小时（早期组）和手术时间>10小时（延迟组）。选择用于比较的终点指标为：1）腹腔镜转为开腹手术的比率，2）并发症情况，3）再次入院情况，4）住院时间。病例总数为201例，其中手术时间<10小时组有76例，手术时间>10小时组有125例。手术时间<10小时组的男女比例为54:22，手术时间>10小时组的男女比例为59:66（P<0.001）。早期组的住院时间为75.52小时，延迟组为89.15小时（P = 0.04）。早期组有1例腹腔内脓肿，延迟组有10例（P = 0.04）。早期组有0.2例（2.6%）转为开腹手术，延迟组有5例（4.1%）（P = 0.58）。延迟组有6例（4.8%）再次入院，早期组无再次入院情况（P = 0.05）。我们的研究表明，延迟组的并发症发生率、住院时间及再次入院率更高。延迟组的转为开腹手术比率更高，但差异不显著。我们得出结论，早期手术干预对急性阑尾炎有益。
