title: Appendectomy timing: Will delayed surgery increase the complications?
abstract: BACKGROUND
  This study investigated whether the time from emergency room registration to appendectomy (ETA) would affect the incidence of perforation and postoperative complications in patients with acute appendicitis.
  
  
  METHODS
  Patients who underwent an appendectomy at the Ren-Ai branch of Taipei City Hospital between January 2010 and October 2012 were retrospectively reviewed. Their demographics, white blood cell count, C-reactive protein, body temperature, computed tomography scan usage, operation method, pathology report, postoperative complication, length of hospital stay, and ETA were abstracted. Multivariate analysis was performed to search the predictors, including ETA, of outcomes for the perforation and postoperative complication rates.
  
  
  RESULTS
  A total of 236 patients were included in the study. Perforation occurred in 12.7% (30/236) and postoperative complications developed in 24.1% (57/236) of these patients. There were 121 patients with ETA <8 hours, 88 patients with ETA of 8-24 hours, and 27 patients with ETA >24 hours; patients with ETA >24 hours had significantly longer hospital stay. Univariate analysis showed that perforated patients were significantly older, and had higher C-reactive protein level, longer hospital stay, and higher complication rate. Patients who developed postoperative complications were significantly older, and had higher neutrophil count, less use of computed tomography, and higher open appendectomy rate. After multivariate analysis, age ≥55 years was the only predictor for perforation [odds ratio (OR) = 3.65; 95% confidence interval (CI), 1.54-8.68]; for postoperative complications, age ≥55 years (OR = 1.65; 95% CI, 1.84-3.25), perforated appendicitis (OR = 3.17; 95% CI, 1.28-7.85), and open appendectomy (OR = 3.21; 95% CI, 1.36-7.58) were associated. ETA was not a significant predictor in both analyses.
  
  
  CONCLUSIONS
  In our study, it was observed that although longer ETA was associated with longer hospitalization, ETA was not correlated with postoperative complications. Our results inclined toward the position that appendectomy can be performed as a semielective surgery.
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan, ROC; Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan, ROC.
authors.forename: Chin-Tsung
authors.initials: CT
authors.lastname: Ting
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan, ROC.
authors.forename: Meng-Jui
authors.initials: MJ
authors.lastname: Tsai
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan, ROC.
authors.forename: Wen-Chang
authors.initials: WC
authors.lastname: Hsu
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan, ROC.
authors.forename: Po-Chun
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan, ROC.
authors.forename: Meng-Dar
authors.initials: MD
authors.lastname: Lee
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan, ROC.
authors.forename: Mao-Ho
authors.initials: MH
authors.lastname: Liu
authors.affiliation: Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: hcshih@vghtpe.gov.tw.
authors.forename: Hsin-Chin
authors.initials: HC
authors.lastname: Shih
mesh_terms: D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D002097:C-Reactive Protein
keywords: appendectomy; complication; delay; outcome