title: Predictors of early outcome after acute appendicitis: is delaying surgery for acute appendicitis an option? A retrospective study.
abstract: OBJECTIVE
  This study analysed the clinical and para-clinical criteria that may allow surgeons and emergency physicians to take a decision regarding the surgery of acute appendicitis.
  
  
  METHODS
  A retrospective analysis was conducted on 284 acute appendicitis patients who underwent surgery between January 2007 and December 2009 in our institution. The registered data were extracted from patient files and statistically analysed. These data included past medical history, clinical, laboratory and imaging data, duration of hospital stay and post-operative complications. Patient delay (time between the appearance of symptoms and patient arrival at the emergency department) and hospital delay (time between hospital arrival and operation) were correctly investigated. Statistical analysis was done by using SPSS software.
  
  
  RESULTS
  The patient delay is significantly increased in relation to the severity of appendicitis: 24 h (10.8-30.8 h) versus 37.4 h (36.8-38 h) (P < 0.05), unlike hospital delay, which remains constant (between simple and severe appendicitis): 7.5 h (5-14.8 h) versus 8 h (5-13 h). In severe appendicitis, the proportion of guarding, rebound tenderness, tachycardia (P < 0.05) and fever (P < 0.005) were significantly high, and leucocytosis (P < 0.05), C-reactive protein (CRP) (P < 0.001) and eosinopaenia [37.0 vs. 72.8 (P < 0.001)] were significantly different. Concerning computed tomography (CT) and echography, perforation, abscess formation (P < 0.05), phlegmon (P < 0.005) and peritonitis (P < 0.05) were significant signs of complicated cases. The length of hospital stay (P < 0.001) and duration of antibiotic therapy (P < 0.001) were statistically significant in cases of complicated appendicitis.
  
  
  CONCLUSIONS
  Patient delay is a determining factor for the grade of appendicitis. It has an influence on the complications, length of hospital stay and duration of antibiotic treatment, unlike hospital delay.
authors.affiliation: Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Youatou Towo
authors.affiliation: Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium. ahmadsabrycts@hotmail.com.
authors.forename: A S E
authors.initials: AS
authors.lastname: Ramadan
authors.affiliation: Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Ngatchou
authors.affiliation: Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium.
authors.forename: J N
authors.initials: JN
authors.lastname: Djiélé
authors.affiliation: Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Etienne
authors.affiliation: Department of General Surgery, Saint Pierre University Hospital, Brussels, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Capelluto
authors.affiliation: Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium.
authors.forename: Pr P
authors.initials: PP
authors.lastname: Mols
keywords: Appendectomy; Laparoscopy; McBurney’s sign; Perforation; Rebound
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