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Is It Harmful to Delay Appendectomy?

12- to 24-hour delays might not affect outcomes in clinically stable patients.

Traditionally, patients with appendicitis undergo appendectomy as soon as possible after diagnosis. In this retrospective study from a community teaching hospital, researchers sought to determine whether 12-hour delays (for example, to avoid operating in the middle of the night) compromise clinical outcomes.

During a 3-year period, 309 adults underwent appendectomy and had pathologic confirmation of appendicitis; 233 patients underwent surgery within 12 hours of presenting to the hospital, and 76 underwent surgery from 12 to 24 hours after presentation. Age, sex distribution, initial white-blood cell count, and temperature were similar in the two groups. No significant differences were noted for operative time, complications, or length of hospital stay.

Comment: Based on these results, the authors argue that short delays to avoid surgery in the middle of the night might be acceptable for clinically stable patients so that surgery can be performed by a well-rested surgeon in the morning. However, the study has several limitations: It probably was underpowered to detect small differences in outcomes, and the early- and delayed-surgery groups might have had subtle clinical differences at baseline that weren't captured in this simple analysis.

— Allan S. Brett, MD

Published in Journal Watch General Medicine June 6, 2006

Citation(s):

Abou-Nukta F et al. Effects of delaying appendectomy for acute appendicitis for 12 to 24 hours. Arch Surg 2006 May; 141:504-7.

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