In-hospital Delay Increases the Risk of Perforation in Adults with Appendicitis

The influence of in-hospital delay (time between admission and operation) on outcome after appendectomy is controversial.

A total of 1,827 adult patients underwent open or laparoscopic appendectomy for suspected appendicitis in eleven Swiss hospitals between 2003 and 2006. Of these, 1,675 patients with confirmed appendicitis were included in the study. Groups were defined according in-hospital delay (≤12 vs. >12 h).

Delay > 12 h was associated with a significantly higher frequency of perforated appendicitis (29.7 vs. 22.7%; P = 0.010) whereas a delay of 6 or 9 h was not. Size of institution, time of admission, and surgical technique (laparoscopic vs. open) were independent factors influencing in-hospital delay. Admission during regular hours was associated with higher age, higher frequency of co-morbidity, and higher perforation rate compared to admission after hours. The logistic regression identified four independent factors associated with an increased perforation rate: age (≤65 years vs. >65 years, odds ratio (OR) 4.5, P < 0.001); co-morbidity (Charlson index > 0 vs. Charlson index = 0, OR 2.3, P < 0.001); time of admission (after hours vs. regular hours, OR 0.8, P = 0.040), in-hospital delay (>12 vs. ≤12 h, OR 1.5, P = 0.005). Perforation was associated with an increased reintervention rate (13.4 vs. 1.6%; P < 0.001) and longer length of hospital stay (9.5 vs. 4.4 days; P < 0.001).

In-hospital delay negatively influences outcome after appendectomy. In-hospital delay of more than 12 h, age over 65 years, time of admission during regular hours, and the presence of co-morbidity are all independent risk factors for perforation. Perforation was associated with a higher reintervention rate and increased length of hospital stay.