Appendicitis is among the more common surgical conditions of childhood. Delays in seeking care can contribute to the risk of developing complicated appendicitis. Complicated appendicitis requires considerably more resources and intervention.
In a recent study, the relationship between delay in surgery and the risk for complicated appendicitis was evaluated. The data were obtained from the National Surgical Quality Improvement Program and the analysis included 2013 and 2014 data submitted by 29 member hospitals.The analysis included 2429 children.
The data were from children seen only at the treatment hospital to eliminate delays in care experienced when patients presented first to outlying hospitals. Patients who had a CT were excluded because CT provides more detail about the status of the appendix and influences treatment beyond what clinical examination and ultrasound might indicate.
"Time to appendectomy" was calculated as the time between emergency department registration and the time of surgery. This study included children who had an appendectomy within the first 24 hours.
Patients were classified as having complicated appendicitis if they had a perforation, purulent fluid in the peritoneal cavity, an intra-abdominal abscess, or a faecolith in the peritoneal cavity.
The median time to appendectomy was 7.4 hours among all children at all hospitals. Overall, 23.6% of the children developed complicated appendicitis. In this study it was found that children with less than 8 years and female sexhad more incidence of associated with complicated appendicitis.
Among all children, the median length of hospital stay was 2 days. Although delayed time to appendectomy was associated with a longer length of stay, it was not associated with such secondary outcomes as increased risk for infection, the need for drainage procedures, the risk of requiring an unplanned repeat procedure, or repeat presentation to a hospital.
The investigators concluded that the timing of appendectomy, within the first 24 hours, does not appear to be related to the risk for complicated appendicitis.