Hillel Yaffe Medical Center, Hadera, Israel.
General Surgery Department, Rambam Medical Center, HaAliya HaShniya St 8, 3109601, Haifa, Israel.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):3879-3886. doi: 10.1007/s00068-022-01912-3. Epub 2022 Feb 24.
Current practice allows for surgery for acute appendicitis to be delayed up to 24 h in the belief that there will be no increase in complicated appendicitis rates. We evaluated the combined effect of Patient Time (between symptom onset and hospital admission) and Hospital Time (between hospital admission and surgery) on the surgical outcome. We hypothesized that in patients with a short Patient Time, increased Hospital Times will be associated with a higher rate of complicated appendicitis, even in patients operated within 24 h.
Retrospective evaluation of medical files of patients operated for acute appendicitis between 12/2006 and 12/2016.
Of 2749 patients with acute appendicitis included in this analysis, 818 (29.8%) were admitted with symptom onset the same day as admission, 577 (21.0%) reported symptom onset had started the previous day but less than 24 h before admission, and 1354 (49.3%) had over 24 h of symptoms. In patients with symptom onset the same day, a gradual increase in the rate of complicated appendicitis was noted with increasing Hospital Times (≤ 6 h-6.3%; 6-12 h-9.9%; 12-18 h-14.7%; and 18-24 h-12.7%; p = 0.017). In all other patients no differences in the rate of complicated appendicitis were noted as long as the patients were operated within 24 h of admission.
In patients with a short Patient Time, delaying operation is associated with an increased rate of complicated appendicitis and this group of patients should be prioritized for early surgery.
Study registered as ClinicalTrials.gov Identifier: NCT04689906 ( https://clinicaltrials.gov/ct2/show/NCT04689906?term=ashkenazi+itamar&draw=2&rank=2 ).
目前的实践允许急性阑尾炎手术延迟 24 小时，因为人们相信不会增加复杂阑尾炎的发生率。我们评估了患者时间（从症状发作到入院）和医院时间（从入院到手术）的综合影响对手术结果的影响。我们假设在患者的患者时间较短的情况下，增加医院时间将与更高的复杂阑尾炎发生率相关，即使在 24 小时内进行手术的患者也是如此。
回顾性评估 2006 年 12 月至 2016 年 12 月期间接受急性阑尾炎手术的患者的病历。
在本分析中，2749 例急性阑尾炎患者中，818 例（29.8%）入院时症状发作与入院当天相同，577 例（21.0%）报告症状发作前一天开始，但入院前不到 24 小时，1354 例（49.3%）有超过 24 小时的症状。在症状发作当天的患者中，随着医院时间的增加，复杂阑尾炎的发生率逐渐增加（≤6 小时-6.3%；6-12 小时-9.9%；12-18 小时-14.7%；18-24 小时-12.7%；p=0.017）。在所有其他患者中，只要在入院后 24 小时内进行手术，复杂阑尾炎的发生率没有差异。
在患者的患者时间较短的情况下，延迟手术与复杂阑尾炎发生率增加相关，这组患者应优先进行早期手术。
该研究在 ClinicalTrials.gov 注册为标识符：NCT04689906（https://clinicaltrials.gov/ct2/show/NCT04689906？term=ashkenazi+itamar&draw=2&rank=2）。
