Emergent Versus Urgent Uncomplicated Appendicectomy at Al-Diwaniayh Teaching Hospital
DOI:
https://doi.org/10.51699/ijhsms.v3i4.124Keywords:
Appendicitis, Surgery Timing, Uncomplicated Cases, Operative Outcomes, Hospital ResourcesAbstract
Acute appendicitis is the most common cause of acute abdomen in young adults, with surgery as the standard treatment. Recent studies suggest conservative management for uncomplicated cases, though the optimal timing for surgery remains debated. This prospective cohort study at Al-Diwaniayh Teaching Hospital, conducted between November 2021 and December 2022, compared outcomes of patients undergoing surgery within 10 hours (emergent) versus after 10 hours (urgent). Of 839 patients, 725 met the inclusion criteria, with a mean age of 25.48 years. Group 1 (406 patients) and Group 2 (319 patients) showed no significant differences in white blood cell counts, operative times, or post-operative outcomes, including length of hospital stay and complications. These findings suggest that for uncomplicated acute appendicitis, appendectomy can be safely performed within 24 hours, allowing flexibility based on hospital resources without increased risks of complications.
References
D. J. Humes and J. Simpson, "Acute Appendicitis," BMJ, vol. 333, pp. 530-534, 2006. DOI: https://doi.org/10.1136/bmj.38940.664363.AE
C. L. Temple, S. A. Huchcroft, and W. J. Temple, "The Natural History of Appendicitis in Adults: A Prospective Study," Ann. Surg., vol. 221, no. 3, pp. 278-281, 1995. DOI: https://doi.org/10.1097/00000658-199503000-00010
S. Eldar, E. Nash, E. Sabo, I. Matter, J. Kunin, J. G. Mogilner, and J. Abrahamson, "Delay of Surgery in Acute Appendicitis," Am. J. Surg., vol. 173, no. 3, pp. 194-198, 1997. DOI: https://doi.org/10.1016/S0002-9610(96)00011-6
J. Hansson, U. Korner, A. Khorram-Manesh, A. Solberg, and K. Lundholm, "Randomized Clinical Trial of Antibiotic Therapy Versus Appendicectomy as Primary Treatment of Acute Appendicitis in Unselected Patients," Br. J. Surg., vol. 96, no. 5, pp. 473-481, 2009. DOI: https://doi.org/10.1002/bjs.6482
J. Styrud, S. Eriksson, I. Nilsson, G. Ahlberg, S. Haapaniemi, G. Neovius, L. Rex, I. Badume, and L. Granstrom, "Appendectomy Versus Antibiotic Treatment in Acute Appendicitis: A Prospective Multicenter Randomized Controlled Trial," World J. Surg., vol. 30, no. 6, pp. 1033-1037, 2006. DOI: https://doi.org/10.1007/s00268-005-0304-6
K. K. Varadhan, D. J. Humes, K. R. Neal, and D. N. Lobo, "Antibiotic Therapy Versus Appendectomy for Acute Appendicitis: A Meta-Analysis," World J. Surg., vol. 34, no. 2, pp. 199-209, 2010. DOI: https://doi.org/10.1007/s00268-009-0343-5
K. Liu and L. Fogg, "Use of Antibiotics Alone for Treatment of Uncomplicated Acute Appendicitis: A Systematic Review and Meta-Analysis," Surgery, vol. 150, no. 4, pp. 673-683, 2011. DOI: https://doi.org/10.1016/j.surg.2011.08.018
K. Nagpal, N. Udgiri, N. Sharma, E. Curras, J. M. Cosgrove, and D. T. Farkas, "Delaying an Appendectomy: Is it Safe?," Am. Surg., vol. 78, no. 8, pp. 897-900, 2012. DOI: https://doi.org/10.1177/000313481207800827
N. Udgiri, E. Curras, V. K. Kella, K. Nagpal, and J. Cosgrove, "Appendicitis: Is It an Emergency?," Am. Surg., vol. 77, no. 7, pp. 898-901, 2011. DOI: https://doi.org/10.1177/000313481107700727
G. Giraudo, F. Baracchi, L. Pellegrino, H. M. DalCorso, and F. Borghi, "Prompt or Delayed Appendectomy? Influence of Timing of Surgery for Acute Appendicitis," Surg. Today, vol. 43, no. 4, pp. 392-396, 2013. DOI: https://doi.org/10.1007/s00595-012-0250-5
M. F. Ditillo, J. D. Dziura, and R. Rabinovici, "Is It Safe to Delay Appendectomy in Adults With Acute Appendicitis?," Ann. Surg., vol. 244, no. 5, pp. 656-660, 2006. DOI: https://doi.org/10.1097/01.sla.0000231726.53487.dd
M. Mohammadi, H. Song, and Y. Cao, "Risk of Lymphoid Neoplasms in a Swedish Population-Based Cohort of 337,437 Patients Undergoing Appendectomy," Scand. J. Gastroenterol., vol. 51, pp. 583-589, 2016. DOI: https://doi.org/10.3109/00365521.2015.1124450
M. J. H. Girard-Madoux, M. Gomez de Aguero, S. C. Ganal-Vonarburg, et al., "The Immunological Functions of the Appendix: An Example of Redundancy?," Semin. Immunol., vol. 36, pp. 31-44, 2018. DOI: https://doi.org/10.1016/j.smim.2018.02.005
S. Sahami, I. A. Kooij, S. L. Meijer, G. R. Van den Brink, C. J. Buskens, and A. A. Te Velde, "The Link Between the Appendix and Ulcerative Colitis: Clinical Relevance and Potential Immunological Mechanisms," Am. J. Gastroenterol., vol. 111, no. 2, pp. 163-169, 2016. DOI: https://doi.org/10.1038/ajg.2015.301
J. B. Prystowsky, C. M. Pugh, and A. P. Nagle, "Current Problems in Surgery: Appendicitis," Curr. Probl. Surg., vol. 42, pp. 688-742, 2005. DOI: https://doi.org/10.1067/j.cpsurg.2005.07.005
S. Deshmukh, F. Verde, P. T. Johnson, et al., "Anatomical Variants and Pathologies of the Vermix," Emerg. Radiol., vol. 21, pp. 543-552, 2014. DOI: https://doi.org/10.1007/s10140-014-1206-4
D. G. Addiss, N. Shaffer, B. S. Fowler, and R. V. Tauxe, "The Epidemiology of Appendicitis and Appendectomy in the United States," Am. J. Epidemiol., vol. 132, no. 5, pp. 910-925, 1990. DOI: https://doi.org/10.1093/oxfordjournals.aje.a115734
H. Song, C. C. Abnet, A. Andrén-Sandberg, A. K. Chaturvedi, and W. Ye, "Risk of Gastrointestinal Cancers Among Patients With Appendectomy: A Large-Scale Swedish Register-Based Cohort Study During 1970-2009," PLoS One, vol. 11, no. 3, p. e0151262, 2016. DOI: https://doi.org/10.1371/journal.pone.0151262
B. A. Birnbaum and S. R. Wilson, "Appendicitis at the Millennium," World J. Surg., vol. 30, no. 6, pp. 1033-1037, 2006.
D. P. Burkitt, "The Aetiology of Appendicitis," Br. J. Surg., vol. 58, no. 9, pp. 695-699, 1971. DOI: https://doi.org/10.1002/bjs.1800580916
E. Arnbjornsson and S. Bengmark, "Obstruction of the Appendix Lumen in Relation to Pathogenesis of Acute Appendicitis," Acta Chir. Scand., vol. 149, no. 8, pp. 789-791, 1983.
W. Y. Lau, C. H. Teoh-Chan, S. T. Fan, W. C. Yam, K. F. Lau, and S. H. Wong, "The Bacteriology and Septic Complication of Patients with Appendicitis," Ann. Surg., vol. 200, no. 5, pp. 576-581, 1984. DOI: https://doi.org/10.1097/00000658-198411000-00003
R. S. Bennion, E. J. Baron, J. E. Thompson Jr., et al., "The Bacteriology of Gangrenous and Perforated Appendicitis Revisited," Ann. Surg., vol. 211, no. 2, pp. 165-171, 1990. DOI: https://doi.org/10.1097/00000658-199002000-00008
R. Andersson, A. Hugander, A. Thulin, G. Nyström, and G. Olaison, "Indications for Operation in Suspected Appendicitis and Incidence of Perforation," BMJ, vol. 308, no. 6921, pp. 107-110, 1994. DOI: https://doi.org/10.1136/bmj.308.6921.107
D. W. Song, B. K. Park, S. W. Suh, et al., "Bacterial Culture and Antibiotic Susceptibility in Patients with Acute Appendicitis," Int. J. Colorectal Dis., vol. 33, pp. 441-447, 2018. DOI: https://doi.org/10.1007/s00384-018-2992-z
W. Silen, Cope's Early Diagnosis of the Acute Abdomen, 22nd ed. New York: Oxford University Press, 2010.
H. Körner, K. Söndenaa, J. A. Söreide, et al., "Incidence of Acute Nonperforated and Perforated Appendicitis: Age-Specific and Sex-Specific Analysis," World J. Surg., vol. 21, no. 3, pp. 313-317, 1997. DOI: https://doi.org/10.1007/s002689900235
R. E. Andersson, "Meta-Analysis of the Clinical and Laboratory Diagnosis of Appendicitis," Br. J. Surg., vol. 91, no. 1, pp. 28-37, 2004. DOI: https://doi.org/10.1002/bjs.4464
A. Acharya, S. R. Markar, M. Ni, and G. B. Hanna, "Biomarkers of Acute Appendicitis: Systematic Review and Cost-Benefit Tradeoff Analysis," Surg. Endosc., vol. 31, no. 3, pp. 1022-1031, 2017. DOI: https://doi.org/10.1007/s00464-016-5109-1
C. J. Wray, L. S. Kao, S. G. Millas, et al., "Acute Appendicitis: Controversies in Diagnosis and Management," Curr. Probl. Surg., vol. 50, pp. 54-86, 2013. DOI: https://doi.org/10.1067/j.cpsurg.2012.10.001
S. Di Saverio, A. Birindelli, M. D. Kelly, et al., "WSES Jerusalem Guidelines for Diagnosis and Treatment of Acute Appendicitis," World J. Emerg. Surg., vol. 11, p. 34, 2016. DOI: https://doi.org/10.1186/s13017-016-0090-5
R. R. Gorter, H. H. Eker, M. A. Gorter-Stam, et al., "Diagnosis and Management of Acute Appendicitis: EAES Consensus Development Conference 2015," Surg. Endosc., vol. 30, pp. 4668-4690, 2016. DOI: https://doi.org/10.1007/s00464-016-5245-7
A. Alvarado, "A Practical Score for the Early Diagnosis of Acute Appendicitis," Ann. Emerg. Med., vol. 15, pp. 557-564, 1986. DOI: https://doi.org/10.1016/S0196-0644(86)80993-3
S. W. Anderson, J. A. Soto, B. C. Lucey, et al., "Abdominal 64-MDCT for Suspected Appendicitis: The Use of Oral and IV Contrast Material Versus IV Contrast Material Only," AJR Am. J. Roentgenol., vol. 193, no. 5, pp. 1282-1288, 2009. DOI: https://doi.org/10.2214/AJR.09.2336
M. P. Smith, D. S. Katz, T. Lalani, et al., "ACR Appropriateness Criteria Right Lower Quadrant Pain-Suspected Appendicitis," Ultrasound Q., vol. 31, no. 2, pp. 85-91, 2015. DOI: https://doi.org/10.1097/RUQ.0000000000000118
C. Keyzer, M. Zalcman, V. De Maertelaer, et al., "Comparison of US and Unenhanced Multi-Detector Row CT in Patients Suspected of Having Acute Appendicitis," Radiology, vol. 236, no. 2, pp. 527-534, 2005. DOI: https://doi.org/10.1148/radiol.2362040984
N. Kessler, C. Cyteval, B. Gallix, et al., "Appendicitis: Evaluation of Sensitivity, Specificity, and Predictive Values of US, Doppler US, and Laboratory Findings," Radiology, vol. 230, no. 2, pp. 472-478, 2004. DOI: https://doi.org/10.1148/radiol.2302021520
R. L. Barger Jr. and K. R. Nandalur, "Diagnostic Performance of Magnetic Resonance Imaging in the Detection of Appendicitis in Adults: A Meta-Analysis," Acad. Radiol., vol. 17, no. 10, pp. 1211-1216, 2010. DOI: https://doi.org/10.1016/j.acra.2010.05.003
N. A. Parks and T. J. Schroeppel, "Update on Imaging for Acute Appendicitis," Surg. Clin. North Am., vol. 91, pp. 141-154, 2011. DOI: https://doi.org/10.1016/j.suc.2010.10.017
A. S. Earley, J. P. Pryor, P. K. Kim, J. H. Hedrick, J. E. Kurichi, A. C. Minogue, et al., "An Acute Care Surgery Model Improves Outcomes in Patients with Appendicitis," Ann. Surg., vol. 244, pp. 498-504, 2006.
P. G. Teixeira, E. Sivrikoz, K. Inaba, P. Talving, L. Lam, and D. Demetriades, "Appendectomy Timing: Waiting Until the Next Morning Increases the Risk of Surgical Site Infections," Ann. Surg., vol. 256, pp. 538-543, 2012. DOI: https://doi.org/10.1097/SLA.0b013e318265ea13
D. Yardeni, R. B. Hirschl, R. A. Drongowski, D. H. Teitelbaum, J. D. Geiger, and A. G. Coran, "Delayed Versus Immediate Surgery in Acute Appendicitis: Do We Need to Operate During the Night?," J. Pediatr. Surg., vol. 39, pp. 464-469, 2004. DOI: https://doi.org/10.1016/j.jpedsurg.2003.11.020
K. Stahlfeld, J. Hower, S. Homitsky, and J. Madden, "Is Acute Appendicitis a Surgical Emergency?," Am. Surg., vol. 73, pp. 626-630, 2007. DOI: https://doi.org/10.1177/000313480707300616
A. M. Ingraham, M. E. Cohen, K. Y. Bilimoria, et al., "Effect of Delay to Operation on Outcomes in Adults with Acute Appendicitis," Arch. Surg., vol. 145, pp. 886-892, 2010. DOI: https://doi.org/10.1001/archsurg.2010.184
B. J. Eastridge, E. C. Hamilton, G. E. O'Keefe, R. V. Rege, R. J. Valentine, and D. J. Jones, et al., "Effect of Sleep Deprivation on the Performance of Simulated Laparoscopic Surgical Skill," Am. J. Surg., vol. 186, pp. 169-174, 2003. DOI: https://doi.org/10.1016/S0002-9610(03)00183-1
K. Kahol, M. J. Leyba, M. Deka, V. Deka, S. Mayes, and M. Smith, et al., "Effect of Fatigue on Psychomotor and Cognitive Skills," Am. J. Surg., vol. 195, pp. 195-204, 2008. DOI: https://doi.org/10.1016/j.amjsurg.2007.10.004
