title: Delaying an appendectomy: is it safe?
abstract: Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The  goal of our study was to examine the relationship between this delay to surgery and patient outcomes. We reviewed all patients that underwent an appendectomy in our institution from January 2009 to December 2010. We recorded the time of surgical diagnosis from when both the surgical consult  and the CT scan (if done) were completed. The delay from surgical diagnosis to incision was measured, and patients were divided into two groups: early (≤6 hours delay) and late (>6 hours delay). Outcome measures were 30-day complication rate, length of stay, perforation rate, and laparoscopic  to open conversion rate. Three hundred and seventy-seven patients had appendectomies in the study period, and 35 patients were excluded as per the exclusion criteria leaving 342 in the study: 269 (78.7%) in the early group and 73 (21.3%) in the late group. Complications occurred in 21 patients  (6.1%) with no difference between the groups: 16/253 (5.9%) in the early group and 5/73 (6.8%) in the late group (P = 0.93, χ(2)). The mean (± standard deviation) length of stay was 86.1 ± 67.1 hours in the early group, and 95.9 ± 73.0 hours in the  late group. This difference was not significant (P = 0.22). Delaying an appendectomy more than 6 hours, but less than 24 hours from diagnosis is safe and does not lead to worse outcomes. This can help limit the disruption to the schedules of both the surgeon and the operating room.
authors.affiliation: Department of Surgery, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York, USA. knagpal6@gmail.com
authors.forename: Kamal
authors.initials: K
authors.lastname: Nagpal
authors.forename: Navalkishor
authors.initials: N
authors.lastname: Udgiri
authors.forename: Niraj
authors.initials: N
authors.lastname: Sharma
authors.forename: Ernesto
authors.initials: E
authors.lastname: Curras
authors.forename: John Morgan
authors.initials: JM
authors.lastname: Cosgrove
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Farkas
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D016009:Chi-Square Distribution; D004630:Emergencies; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009519:New York City / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome