title: Ideal timing of surgery for acute uncomplicated appendicitis.
abstract: BACKGROUND
  Early surgery for appendicitis is thought to avoid complications associated with appendiceal rupture.
  
  
  OBJECTIVE
  This study was to evaluate the effect of timing of surgery on complications, length of stay (LOS) and cost in patients undergoing appendectomy.
  
  
  METHODS
  Retrospective review of 396 patients with appendectomies from January 1, 2005 to December 31, 2007 was performed. Demographic data, time of presentation, physical findings, diagnostic data, operating room times, LOS, cost and complications were collected. Patients were divided into 4 groups based on time from presentation to appendectomy.
  
  
  RESULTS
  Pathology confirmed appendicitis in 354 (89%) patients. Most patients (90%) had surgery within 18 h of presentation. Timing of surgery did not affect the incidence of purulent peritonitis (P = 0.883), abscess (P = 0.841) or perforation (P = 0.464). LOS was significantly shorter for patients with emergency department registration to operating room times less than 18 h (P < 0.0001). Costs were significantly higher for patients with times to operating room greater than 18 h (P < 0.001).
  
  
  CONCLUSIONS
  Timing of surgery did not affect the incidence of complications or perforated appendicitis. However, delay in surgical consultation and surgery are associated with increased LOS and increased hospital costs. The optimal timing of appendectomy for uncomplicated acute appendicitis appears to be within 18 h of emergency department presentation.
authors: Department of Plastic and Reconstructive Surgery, Tulane University Hospital and Clinics, 1430 Tulane Avenue, New Orleans, Louisiana, USA.
authors: Frederick N
authors: FN
authors: Eko
authors: Gabriel E
authors: GE
authors: Ryb
authors: Leslie
authors: L
authors: Drager
authors: Eva
authors: E
authors: Goldwater
authors: Jacqueline J
authors: JJ
authors: Wu
authors: Timothy C
authors: TC
authors: Counihan
keywords: Appendectomy; Delayed surgery; Hospital costs; Length of stay
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