Will Delay in Surgery Affect Outcome in Acute Appendicitis?

Abstract

ABSTRACT

Introduction: This study was conducted to evaluate the affect of delay in operation from the time of onset of symptoms and from the time the patient reaches the hospital and its outcome in patients who undergo appendicectomy for acute appendicitis.

Methods: All the patients with acute appendicitis who were operated were included in the study. Post-operative complications, mean post-operative hospital stay and histopathological gradings were evaluated in relation to time of onset of symptoms and time from the patient reaches the hospital to the operation theatre.

Results: Total of 76 patients were included in the study. Overall mean hospital stay was 3.71±2.365 days. Negative appendicectomy rate was 10.5% and complication rate was 13.2%. Mean duration of post-operative hospital stay gradually increased as the severity of disease increased though statistically not significant.  Patient’s overall elapsed time of more than 3 days had increased tendency to perforate, which was statistically significant. When the patient presented within 24 hours of symptoms, the pathological severity was low. A significant association between the overall elapse time and a more advanced pathology was found but in-hospital delay was not significantly associated with severe pathological grading. Complications rates were not significantly associated with in-hospital delay of upto 12 hours.

Conclusion: Patient delay beyond three days had higher perforation rate but in-hospital delay of up to 12 hours had no significant complications. Therefore, it is concluded that in-hospital delay of up to 12 hours can be managed without risk of increased complication.

Keywords: Acute appendicitis; Appendicectomy; In-hospital delay ;Patient delay; pathological grading