title: Delay of surgery in acute appendicitis.
abstract: OBJECTIVE
  It is generally assumed that delayed diagnosis of acute appendicitis results in higher morbidity but this assumption is not strongly supported in the literature. We attempt to define the effect of patient and physician delay on the outcome of patients with acute appendicitis.
  
  
  METHODS
  We studied 486 patients admitted between 1980 and 1992. Patient delay in presenting to a physician and surgeon delay from hospital admission to operation were studied in relation to stage of disease at operation as well as to postoperative complications.
  
  
  RESULTS
  Postoperative complications occurred in 10% of cases with simple acute appendicitis versus about 20% of cases with gangrenous or perforated appendicitis (P <0.001). The mean patient delay from onset of symptoms to presentation to a physician was 1.7 days in simple acute appendicitis versus 2.3 days in gangrenous or perforated appendicitis (P <0.001). Mean surgeon delay was 13.6 hours in simple acute appendicitis versus 14.5 hours in advanced appendicitis (P = NS).
  
  
  CONCLUSIONS
  Delay in patient presentation adversely affects the stage of disease in acute appendicitis and leads to increased incidence of infectious complications and to prolonged hospital stay. Conversely, physician delay does not affect the stage of disease. A surgeon's decision to observe patients in hospital in order to clarify the diagnosis is justified, as it does not adversely affect outcome.
authors.affiliation: Department of Surgery, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Eldar
authors.forename: E
authors.initials: E
authors.lastname: Nash
authors.forename: E
authors.initials: E
authors.lastname: Sabo
authors.forename: I
authors.initials: I
authors.lastname: Matter
authors.forename: J
authors.initials: J
authors.lastname: Kunin
authors.forename: J G
authors.initials: JG
authors.lastname: Mogilner
authors.forename: J
authors.initials: J
authors.lastname: Abrahamson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013997:Time Factors