title: High admission C-reactive protein level and longer in-hospital delay to surgery are associated with increased risk of complicated appendicitis.
abstract: OBJECTIVE
  Debate on the effect of in-hospital delay on the risk of perforation in appendicitis persists, and the results from previous studies are controversial. The aims of this study were to present the effect of in-hospital delay on the risk of perforation in appendicitis and to assess the utility of C-reactive protein (CRP) measurement in detecting the patients with complicated appendicitis.
  
  
  METHODS
  Prospectively collected data of 389 adult patients who underwent surgery for acute appendicitis were analyzed in order to find the most accurate method for recognizing the pre-hospital perforations. The effect of in-hospital delay on the further risk of perforation in patients with not yet perforated acute appendicitis was then analyzed.
  
  
  RESULTS
  Out of 389 patients with appendicitis, 91 patients (23.4 %) had complicated appendicitis, 23 with abscess, and 68 with free perforation. Admission CRP level of 99 mg/l or higher was 90.3 % specific for complicated appendicitis. In patients with admission CRP less than 99 mg/l, the incidence of perforation doubled from 9.5 to 18.9 % when the in-hospital delay increased from less than 6 h to more than 12 h.
  
  
  CONCLUSIONS
  Complicated appendicitis can be identified with a high CRP level on admission. Delaying surgery can increase the risk of perforation.
authors.affiliation: Department of Abdominal Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Helsinki, Finland, henna.sammalkorpi@hus.fi.
authors.forename: Henna E
authors.initials: HE
authors.lastname: Sammalkorpi
authors.forename: Ari
authors.initials: A
authors.lastname: Leppäniemi
authors.forename: Panu
authors.initials: P
authors.lastname: Mentula
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods; D001064:Appendicitis / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein