title: Association of Delay in Appendectomy With Perforation in Children With Appendicitis.
abstract: OBJECTIVE
  The aim of this study was to assess whether increased time from emergency department (ED) triage to appendectomy is associated with a greater risk of children developing appendiceal perforation.
  
  
  METHODS
  We performed a multicenter retrospective cohort study of children younger than 18 years hospitalized with appendicitis. To avoid enrolling patients who had perforated prior to ED arrival, we included only children who had a computed tomography (CT) scan demonstrating nonperforated appendicitis. Time to appendectomy was measured as time from ED triage to incision. The main outcome was appendiceal perforation as documented in the surgical report. Variables associated with perforation in bivariate analysis (P < 0.05) were adjusted for using logistic regression.
  
  
  RESULTS
  Overall, 857 patients had a CT scan that demonstrated nonperforated appendicitis. The median age was 12 years (interquartile range, 9-15 years), and 500 (58%) were male. The median time to appendectomy was 11 hours (interquartile range, 8-15 hours). In total, 111 patients (13%) had perforated appendicitis at operation. Children who developed perforation were more likely to require additional CT scans and return to the ED and had a significantly longer length of stay. After adjusting for potential confounders, every hour increase in the time from ED triage to incision was independently associated with a 2% increase in the odds of perforation (P = 0.03; adjusted odds ratio, 1.02; 95% confidence interval, 1.00-1.04).
  
  
  CONCLUSIONS
  Delays in appendectomy were associated with an increase in the odds of perforation. These results suggest that prolonged delays to appendectomy might be harmful for children with appendicitis and should be minimized to prevent associated morbidity.
authors.forename: James A
authors.initials: JA
authors.lastname: Meltzer
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Stony Brook Children's Hospital, SUNY Stony Brook School of Medicine, Stony Brook.
authors.forename: Sergey
authors.initials: S
authors.lastname: Kunkov
authors.affiliation: Division of Pediatrics, Department of Emergency Medicine, Kings County Hospital Center, SUNY Downstate College of Medicine, Brooklyn.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Chao
authors.affiliation: Division of Pediatrics, Department of Emergency Medicine, Kravis Children's Hospital at Mount Sinai, Icahn School of Medicine, New York.
authors.forename: Ee Tein
authors.initials: ET
authors.lastname: Tay
authors.affiliation: Division of Pediatrics, Department of Emergency Medicine, Kings County Hospital Center, SUNY Downstate College of Medicine, Brooklyn.
authors.forename: Jerry P
authors.initials: JP
authors.lastname: George
authors.forename: David
authors.initials: D
authors.lastname: Borukhov
authors.affiliation: Division of Pediatrics, Department of Emergency Medicine, Kravis Children's Hospital at Mount Sinai, Icahn School of Medicine, New York.
authors.forename: Stephen
authors.initials: S
authors.lastname: Alerhand
authors.affiliation: Division of Pediatrics, Department of Emergency Medicine, Kings County Hospital Center, SUNY Downstate College of Medicine, Brooklyn.
authors.forename: Prince A
authors.initials: PA
authors.lastname: Harrison
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Stony Brook Children's Hospital, SUNY Stony Brook School of Medicine, Stony Brook.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hom
authors.forename: Ellen F
authors.initials: EF
authors.lastname: Crain
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology* / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed