Nagpal Kamal, Udgiri Navalkishor, Sharma Niraj, Curras Ernesto, Cosgrove John Morgan, Farkas Daniel T
Department of Surgery, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Am Surg. 2012 Aug;78(8):897-900.
Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The goal of our study was to examine the relationship between this delay to surgery and patient outcomes. We reviewed all patients that underwent an appendectomy in our institution from January 2009 to December 2010. We recorded the time of surgical diagnosis from when both the surgical consult and the CT scan (if done) were completed. The delay from surgical diagnosis to incision was measured, and patients were divided into two groups: early (≤6 hours delay) and late (>6 hours delay). Outcome measures were 30-day complication rate, length of stay, perforation rate, and laparoscopic to open conversion rate. Three hundred and seventy-seven patients had appendectomies in the study period, and 35 patients were excluded as per the exclusion criteria leaving 342 in the study: 269 (78.7%) in the early group and 73 (21.3%) in the late group. Complications occurred in 21 patients (6.1%) with no difference between the groups: 16/253 (5.9%) in the early group and 5/73 (6.8%) in the late group (P = 0.93, χ(2)). The mean (± standard deviation) length of stay was 86.1 ± 67.1 hours in the early group, and 95.9 ± 73.0 hours in the late group. This difference was not significant (P = 0.22). Delaying an appendectomy more than 6 hours, but less than 24 hours from diagnosis is safe and does not lead to worse outcomes. This can help limit the disruption to the schedules of both the surgeon and the operating room.
阑尾炎一直是紧急手术的指征，因为人们认为延迟手术会导致疾病进展，从而导致更差的预后。然而，最近的研究表明，阑尾切除术可以稍微延迟而不会导致更差的预后，不过相关文献存在矛盾之处。我们研究的目的是探讨手术延迟与患者预后之间的关系。我们回顾了2009年1月至2010年12月在我们机构接受阑尾切除术的所有患者。我们记录了从外科会诊和CT扫描（如果进行了）完成时起的手术诊断时间。测量了从手术诊断到切开的延迟时间，并将患者分为两组：早期（延迟≤6小时）和晚期（延迟>6小时）。观察指标包括30天并发症发生率、住院时间、穿孔率和腹腔镜转为开放手术率。在研究期间，有377例患者接受了阑尾切除术，根据排除标准排除了35例患者，最终有342例患者纳入研究：早期组269例（78.7%），晚期组73例（21.3%）。21例患者（6.1%）出现并发症，两组之间无差异：早期组16/253例（5.9%），晚期组5/73例（6.8%）（P = 0.93，χ(2)）。早期组的平均（±标准差）住院时间为86.1±67.1小时，晚期组为95.9±73.0小时。这种差异不显著（P = 0.22）。从诊断起延迟阑尾切除术超过6小时但少于24小时是安全的，不会导致更差的预后。这有助于减少对外科医生和手术室日程安排的干扰。
