The impact of operative timing on outcomes of appendicitis: a National Surgical Quality Improvement Project analysis

Am J Surg. 2015 Mar;209(3):498-502. doi: 10.1016/j.amjsurg.2014.10.013. Epub 2014 Dec 13.

Abstract

Background: Surgery is indicated for acute uncomplicated appendicitis but the optimal timing is controversial. Recent literature is conflicting on the effect of time to intervention.

Methods: We queried the American College of Surgeons National Surgical Quality Improvement Project dataset for patients undergoing laparoscopic and open appendectomy between 2007 and 2012. Logistic regression was used to evaluate 30-day morbidity and mortality of intervention at different time periods, adjusting for preoperative risk factors.

Results: A total of 69,926 patients undergoing appendectomy were identified. Groups were divided by time to intervention: group 1, less than 24 hours (n = 55,839; 79.9%); group 2, 24 to 48 hours (n = 13,409; 18.6%); and group 3, greater than 48 hours (n = 1,038; 1.5%). After adjustment, the risk of complication remained increased for group 3 versus group 1 or 2 (odds ratio 1.66, 95% confidence interval 1.34 to 2.07).

Conclusions: These data demonstrate equivalent outcomes between time to appendectomy of less than 24 and 24 to 48 hours. There was a 2-fold increase in complication rate for patients delayed longer than 48 hours.

Keywords: Laparoscopic appendectomy; NSQIP; Open appendectomy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Appendectomy / methods*
  • Appendicitis / mortality
  • Appendicitis / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Illinois / epidemiology
  • Laparoscopy
  • Length of Stay / trends
  • Male
  • Middle Aged
  • Morbidity / trends
  • Operative Time
  • Postoperative Complications / epidemiology*
  • Quality Improvement / organization & administration*
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Time Factors
  • Treatment Outcome