A COMPARISON BETWEEN PRESENATATION TIME AND DELAY IN SURGERY IN SIMPLE AND ADVANCED APPENDICITIS
AbstractBackground: Acute appendicitis is the most common cause of acute abdomen. Serial examinations and investigations increase diagnostic accuracy. But this causes delay, which may result in gangrene and perforation. Our aim is to determine the affect of delay by the patient as well as by the physician on the stage of the disease as determined intraoperatively and to determine the percentage of negative appendectomies. Methods: 102 consecutive patients presenting to the Mayo Hospital emergency, undergoing appendectomy between February and April, 2002 comprise the study group. Data was tabulated and analyzed. The delay by the patient in presenting to emergency was called the “patient’s delay” and the in-hospital delay before the actual operation called the “physician’s delay” were calculated. The appendicitis was divided into two groups i.e. “simple appendicitis” which included acutely inflamed appendices and grossly mildly or non inflamed but histopathologically inflamed appendicitis and “advanced appendicitis” which included gangrenous and perforated cases. Results: The percentage of negative appendectomy in our center was 5.9%. Patients’ delay averaged 2.59 days and 2.43 days in simple and advanced appendicitis. A prolonged average delay period of 6.12 day was seen in misdiagnosed cases. The mean delay was not significantly different. 86.3% of the patients were operated within 12 hours of presentation. The mean physician’s delay was 9.24 hours. It was significantly shorter for advanced appendicitis as compared to simple appendicitis. Conclusions: Patient’s delay was not associated with advanced appendicitis. It is recognizable clinically and gets operated two hours earlier on average. There is a significant lag period of observation leading to a physician delay in simple appendicitis, contributing possibly to, increased morbidity. However there is an increased need to use ultrasonography and CT in the emergency setting to diagnose appendicitis in case of doubt.Key Words: Appendicitis, negative appendectomies, appendix.
Doharty GM, Lowney JK, Mason JE, Reznik SI, Smith MA. Washington Manual of Surgery. Second Ed Philadelphia. Lippencott Williams & Wilkins;1999.
Russel RCG, Williams NS, Bulstrode CJK. Bailey & Love’s Short Practice of Surgery. Arnold Publishers 23rd Ed. 2000.
McLatchie G. Oxford Handbook of Clinical Surgery. Oxford University Press, London 1991.
Sher KS, Coil JA. The continuing challenge of perforating appendicitis. Surg Gynaecol Obstet 1980;150:535–8.
Samuel E, Nash E. Delay of surgery in acute appendicitis. Am J Surg 1997; 173(3):194–8.
Murphy E, Mealy K. Timing of operation for appendicitis. Brit J Surg 1997;84:1004–1005.
Rao PM, Rhea JT. Introduction of appendicitis CT: Impact on negative appendectomy and appendiceal perforation rates. Ann Surg 1999; 229(3):344– 9.
Culson M, Skinner KA, Dunnington G. High negative appendectomy rated no longer acceptable. Am J Surg 1997;174 (6) 726-7.
Jangling A, Holzgreve A, Kaiser R. Indications for appendectomy from the ultrasound-clinical viewpoint. Zentralbl Chir 1989; 123 (supple 4): 32-7.
Lee HY, Jayalakshami P, Noori SH. Acute Appendicitis – the university hospital experiences. Med J Malayasia 1993;48:17-27.
Styrud J, Josephson T, Eriksson S. Reducing negative appendectomy evaluation of ultrasonography and computerized tomography in appendicitis Intl J Qual Health Care 2000;12(1):65-68
Nguyen DB, Silen W, Hodin RA. Appendectomy in pre and post laproscopic eras. J Gastrointest Surg 1999;3(1):67-73.
Corvantes S, Sanches CR. Syringe pressure irrigation of subdermic tissue after appendectomy to decrease the incidence of postoperative wound infection. World J Surg 2000;24(1):41- 42.
Barkhausen S, Wullstein C, Gross E. Laparoscopic versus conventional appendectomy – a comparison with reference to early postoperative complications. Zentalbl Chir 1998;123(7):858 – 62.
Maynaud RA, Kraemer L, Colin C. Wound infection in open versus laparoscopic appendectomy:A metaanalysis. Int J Techno Assess Health 1999;15(2):380-91.