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In-hospital Delay Increases the Risk of Perforation in Adults with Appendicitis


Busch, Mirjam; Gutzwiller, Florian S; Aellig, Sonja; Kuettel, Rolf; Metzger, Urs; Zingg, Urs (2011). In-hospital Delay Increases the Risk of Perforation in Adults with Appendicitis. World Journal of Surgery, 35(7):1626-1633.

Abstract

Background: The influence of in-hospital delay (time between admission and operation) on outcome after appendectomy is controversial. Methods: A total of 1,827 adult patients underwent open or laparoscopic appendectomy for suspected appendicitis in eleven Swiss hospitals between 2003 and 2006. Of these, 1,675 patients with confirmed appendicitis were included in the study. Groups were defined according in-hospital delay (≤12 vs. >12h). Results: Delay>12h was associated with a significantly higher frequency of perforated appendicitis (29.7 vs. 22.7%; P=0.010) whereas a delay of 6 or 9h was not. Size of institution, time of admission, and surgical technique (laparoscopic vs. open) were independent factors influencing in-hospital delay. Admission during regular hours was associated with higher age, higher frequency of co-morbidity, and higher perforation rate compared to admission after hours. The logistic regression identified four independent factors associated with an increased perforation rate: age (≤65years vs. >65years, odds ratio (OR) 4.5, P<0.001); co-morbidity (Charlson index>0 vs. Charlson index=0, OR 2.3, P<0.001); time of admission (after hours vs. regular hours, OR 0.8, P=0.040), in-hospital delay (>12 vs. ≤12h, OR 1.5, P=0.005). Perforation was associated with an increased reintervention rate (13.4 vs. 1.6%; P<0.001) and longer length of hospital stay (9.5 vs. 4.4days; P<0.001). Conclusions: In-hospital delay negatively influences outcome after appendectomy. In-hospital delay of more than 12h, age over 65years, time of admission during regular hours, and the presence of co-morbidity are all independent risk factors for perforation. Perforation was associated with a higher reintervention rate and increased length of hospital stay

Abstract

Background: The influence of in-hospital delay (time between admission and operation) on outcome after appendectomy is controversial. Methods: A total of 1,827 adult patients underwent open or laparoscopic appendectomy for suspected appendicitis in eleven Swiss hospitals between 2003 and 2006. Of these, 1,675 patients with confirmed appendicitis were included in the study. Groups were defined according in-hospital delay (≤12 vs. >12h). Results: Delay>12h was associated with a significantly higher frequency of perforated appendicitis (29.7 vs. 22.7%; P=0.010) whereas a delay of 6 or 9h was not. Size of institution, time of admission, and surgical technique (laparoscopic vs. open) were independent factors influencing in-hospital delay. Admission during regular hours was associated with higher age, higher frequency of co-morbidity, and higher perforation rate compared to admission after hours. The logistic regression identified four independent factors associated with an increased perforation rate: age (≤65years vs. >65years, odds ratio (OR) 4.5, P<0.001); co-morbidity (Charlson index>0 vs. Charlson index=0, OR 2.3, P<0.001); time of admission (after hours vs. regular hours, OR 0.8, P=0.040), in-hospital delay (>12 vs. ≤12h, OR 1.5, P=0.005). Perforation was associated with an increased reintervention rate (13.4 vs. 1.6%; P<0.001) and longer length of hospital stay (9.5 vs. 4.4days; P<0.001). Conclusions: In-hospital delay negatively influences outcome after appendectomy. In-hospital delay of more than 12h, age over 65years, time of admission during regular hours, and the presence of co-morbidity are all independent risk factors for perforation. Perforation was associated with a higher reintervention rate and increased length of hospital stay

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Item Type:Journal Article, refereed, original work
Communities & Collections:National licences > 142-005
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Surgery
Language:English
Date:1 July 2011
Deposited On:04 Jul 2019 15:00
Last Modified:31 Jul 2020 02:51
Publisher:Springer
ISSN:0364-2313
OA Status:Green
Publisher DOI:https://doi.org/10.1007/s00268-011-1101-z
Related URLs:https://www.swissbib.ch/Search/Results?lookfor=nationallicencespringer101007s002680111101z (Library Catalogue)

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