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May 2011

Delayed Appendectomy

Author Affiliations

Author Affiliation: Rehabilitation Associate of Northern Illinois, Rockford.

Arch Surg. 2011;146(5):632-633. doi:10.1001/archsurg.2011.88

The article published by Ingraham et al1 in the September 2010 issue of Archives of Surgery is a large retrospective cohort study with a prospective view on the national level regarding the timing of appendectomy in acute appendicitis. Two studies2,3 from 2 comparable teaching institutions, one for and the other against early appendectomy, have been published in the past. The national study by Ingraham et al1 shows that, in spite of previous publications regarding delaying appendectomy for 12 to 24 hours, 75.2% of patients had an urgent appendectomy within 6 hours after presentation in the emergency department. Current and previous studies show that the results of delayed and urgent appendectomies are the same. Therefore, the benefits of avoiding urgent appendectomies would be that of cost containment, and that surgeons and/or trainees would not lose sleep and thus perform better during regular hours. The study by Ingraham et al1 shows that the mean length of stay is 1.8 days for patients who have had an appendectomy less than 12 hours after diagnosis and 2.19 days for patients who have had an appendectomy more than 12 hours after diagnosis. Patients who have had an uncomplicated appendectomy, by either an open or laparoscopic approach, can be discharged within 24 hours. Therefore, a delayed appendectomy is not at all cost-effective. Currently, in level I and level II trauma centers in the United States, trauma teams work around-the-clock and perform all types of acute emergency surgery.4 Therefore, the attending surgeon, the trainee, and the operating room crew need not report to the hospital to perform an urgent appendectomy. In small community hospitals, the members of a surgical team live only a stone's throw away from the hospital, and it is no trouble for them to come to the hospital in the middle of the night to perform an urgent appendectomy. After all, the old dictum is that acute appendicitis is a surgical emergency. Acute appendicitis is the most common type of emergency surgery, especially in pediatric patients.

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