title: Delay Between Onset of Symptoms and Surgery in Acute Appendicitis Increases Perioperative Morbidity: A Prospective Study.
abstract: Despite significant progress in surgery, controversy persists about timing of appendectomy. Objective of this prospective observational study was to determine associations between time interval from onset of symptoms in appendicitis to appendectomy and postoperative complications.
  
  
  
  After institutional review board approval, all adult consecutive patients subjected to emergency appendectomy between 1/9/2013 and 1/12/2014 were prospectively enrolled. Data collection included demographics, open vs. laparoscopic appendectomy, comprehensive complication index (CCI), and 30-day follow-up. To determine time-dependent associations between delay of surgery and complications all patients were stratified into subgroups based on 12-h time intervals from onset of abdominal pain to surgery. Primary outcome was complications per CCI in correlation to delay from symptoms to appendectomy. Secondary outcomes included duration of surgery, hospital length of stay (HLOS), and incidence of complication within 30-day follow-up.
  
  
  
  A total of 266 patients with a mean age of 35.4 ± 14.8 years met inclusion criteria. Overall, 83.1 % of patients were subjected to laparoscopic appendectomy. Delay to surgery in 12-h increments showed stepwise-adjusted increase in complications per CCI (adj. P = 0.037). Also, delay to appendectomy increased significantly duration of surgery and HLOS, respectively (adj. P < 0.001 and adj. P < 0.001). Overall, 5.7 % of patients developed a surgical site infection after hospital discharge.
  
  
  
  Extended time interval from the onset of initial symptoms to appendectomy is associated with increased complications per CCI, duration of surgery, and HLOS in acute appendicitis. Prompt appendectomy in acute appendicitis is warranted.
authors.affiliation: School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
authors.forename: Sten
authors.initials: S
authors.lastname: Saar
authors.affiliation: School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia. peep.talving@ut.ee.|Department of Surgery, Tartu University Hospital, Puusepa 1a, 50406, Tartu, Estonia. peep.talving@ut.ee.|Department of Surgery, School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia. peep.talving@ut.ee.
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.affiliation: School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
authors.forename: Juhan
authors.initials: J
authors.lastname: Laos
authors.affiliation: School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.|Department of Surgery, Tartu University Hospital, Puusepa 1a, 50406, Tartu, Estonia.
authors.forename: Taavi
authors.initials: T
authors.lastname: Põdramägi
authors.affiliation: School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
authors.forename: Maksim
authors.initials: M
authors.lastname: Sokirjanski
authors.affiliation: Division of Trauma, Hand and Reconstructive Surgery, Goethe University Hospital, Frankfurt/Main, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lustenberger
authors.affiliation: Division of Acute Care Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.affiliation: School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.|Department of Surgery, Tartu University Hospital, Puusepa 1a, 50406, Tartu, Estonia.|Department of Surgery, School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
authors.forename: Urmas
authors.initials: U
authors.lastname: Lepner
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*; D061665:Time-to-Treatment; D055815:Young Adult
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