Louis M. Bell, MD reviewing Serres SK et al. JAMA Pediatr 2017 Jun 19. Landisch RM et al. JAMA Pediatr 2017 Jun 19.

The time to appendectomy, if performed within 24 hours of presentation, was not associated with perforation or other complications.

Although studies are inconclusive, many physicians feel that a delay in appendectomy may result in complications (perforation) and prolonged hospital stay. Using the Pediatric National Surgical Quality Improvement Program database, researchers examined time to appendectomy (TTA) and its association with complications for 2429 children (age <18 years) who had appendectomies within 24 hours of emergency department (ED) admission in 2013 and 2014. Patients who were evaluated and then referred and those who had a computed tomography scan prior to appendectomy were excluded.

The median TTA (time from ED registration to skin incision) for all 23 hospitals was 7.4 hours (range, 5.0 to 19.2 hours). Overall, 23.6% of patients had complicated appendicitis. In multivariable analysis, increased risk for complicated appendicitis was associated with age <7 years, female sex, and Hispanic ethnicity. Longer TTA was not associated with increased risk for complications or adverse postoperative events (e.g., surgical site infections). However, the longer the TTA, the longer the length of stay, with each 1-hour delay translating to a 1.4-hour longer stay. Within each hospital, a TTA longer than that hospital's median was not associated with adverse postoperative events.

Citation(s):

Serres SK et al. Time to appendectomy and risk of complicated appendicitis and adverse outcomes in children. JAMA Pediatr 2017 Jun 19; [e-pub].

Landisch RM et al. Emergent or urgent appendectomy? — A changing perspective. JAMA Pediatr 2017 Jun 19; [e-pub].

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