Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 1/2019

01-01-2019 | Review Article

Effect of Delay to Operation on Outcomes in Patients with Acute Appendicitis: a Systematic Review and Meta-analysis

Authors: Jian Li, Run Xu, Deng-Min Hu, Yao Zhang, Tu-Ping Gong, Xue-Lian Wu

Published in: Journal of Gastrointestinal Surgery | Issue 1/2019

Login to get access

Abstract

Background

Many studies have investigated the association between time interval and incidence of complicated appendicitis and post-operative surgical site infection (SSI), but the results are controversial.

Methods

A systematic search of the electronic databases identified studies that investigated the association of appendectomy delay with complicated appendicitis and SSI among patients with acute appendicitis. Qualitative and quantitative meta-analysis of the results was conducted.

Results

Twenty-one studies were included in the final analysis. Meta-analysis showed no significant difference in complicated appendicitis incidence between patients in the 6–12 h, > 12 and < 6 h groups (OR 1.07, 95% CI 0.89–1.30, p = 0.47; OR 1.04, 95% CI 0.88–1.22, p = 0.64). Comparison of the 6–12 h category with the < 6 h category of in-hospital delay revealed significant associations between longer in-hospital delay and increased risk of post-operative SSI (OR 1.40, 95% CI 1.11–1.77, p = 0.004). Patients in the 24–48 h category had 1.99- and 1.84-fold (p < 0.05) higher odds of developing complicated appendicitis compared to patients in the < 24 h category for pre-hospital delay and total delay, respectively (OR 1.99, 95% CI 1.35–2.94, p = 0.0006; OR 1.84, 95% CI 1.05–3.21, p = 0.03). When pre-hospital and total delay time extended to more than 48 h, the odds of risk increased 4.62- and 7.57-fold, respectively (OR 4.62, 95% CI 2.99–7.13, p < 0.00001; OR 7.57, 95% CI 6.14–9.35, p = < 0.00001).

Conclusion

Complicated appendicitis incidence was associated with overall elapsed time from symptom onset to admission or operation; short appendectomy in-hospital delay did not increase the risk of complicated appendicitis but was associated with a slightly increased risk of SSI. Prompt surgical intervention is warranted to avoid additional morbidity, enabling quicker recovery in this population.
Literature
1.
Anderson JE, Bickler SW, Chang DC, Talamini MA. Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California, 1995–2009. World J Surg 2012;36:2787–2794.CrossRefPubMed
2.
Cueto J, D'Allemagne B, Vázquez-Frias JA, Gomez S, Delgado F, Trullenque L, Fajardo R, Valencia S, Poggi L, Ballí J, Diaz J, González R, Mansur JH, Franklin ME. Morbidity of laparoscopic surgery for complicated appendicitis: an international study. Surg Endosc 2006;20:717–720.CrossRefPubMed
3.
Yaghoubian A, de Virgilio C, Lee SL. Appendicitis outcomes are better at resident teaching institutions: a multi-institutional analysis. Am J Surg 2010;200:810–813.CrossRefPubMed
4.
Gandy RC, Truskett PG, Wong SW, Smith S, Bennett MH, Parasyn AD. Outcomes of appendicectomy in an acute care surgery model. Med J Aust 2010;193:281–284.PubMed
5.
6.
7.
8.
Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg 2006;202:401–406.CrossRefPubMed
9.
Teixeira PG, Sivrikoz E, Inaba K, Talving P, Lam L, Demetriades D. Appendectomy timing: waiting until the next morning increases the risk of surgical site infections. Ann Surg 2012;256:538–543.CrossRefPubMed
10.
Eldar S, Nash E, Sabo E, Matter I, Kunin J, Mogilner JG, Abrahamson J. Delay of surgery in acute appendicitis. Am J Surg 1997;173:194–198.CrossRefPubMed
11.
12.
Abou-Nukta F, Bakhos C, Arroyo K, Koo Y, Martin J, Reinhold R, Ciardiello K. Effects of delaying appendectomy for acute appendicitis for 12–24 h. Arch Surg 2006;141:504–506. CrossRefPubMed
13.
Eastridge BJ, Hamilton EC, O’Keefe GE, Rege RV, Valentine RJ, Jones DJ, Tesfay S, Thal ER. Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill. Am J Surg 2003;186:169–174.CrossRefPubMed
14.
Andersson R, Hugander A, Thulin A, Nyström PO, Olaison G. Indications for operation in suspected appendicitis and incidence of perforation. BMJ 1994;308:107–110.CrossRefPubMedPubMedCentral
15.
Ciani S, Chuaqui B. Histological features of resolving acute, non-complicated phlegmonous appendicitis. Pathol Res Pract 2000;196:89–93.CrossRefPubMed
16.
Stahlfeld K, Hower J, Homitsky S, Madden J. Is acute appendicitis a surgical emergency? Am Sur 2007;73:626–629.
17.
Kearney D, Cahill RA, O'Brien E, Kirwan WO, Redmond HP. Influence of delays on perforation risk in adults with acute appendicitis. Dis Colon Rectum 2008;51:1823–1827.CrossRefPubMed
18.
Ingraham AM, Cohen ME, Bilimoria K, Ko C, Hall BL, Russell TR, Nathens AB. Effect of delay to operation on outcomes in adults with acute appendicitis. Arch Surg 2010;145:886–892.CrossRefPubMed
19.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008–2012.CrossRefPubMed
20.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010;8:336–341.CrossRefPubMed
21.
Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. Available at: http://​www.​ohri.​ca/​programs/​clinical epidemiology/oxford web.ppt. Accessed October 2013.
22.
Hernandez AV, Pasupuleti V, Benites-Zapata VA, Thota P, Deshpande A, Perez-Lopez FR. Insulin resistance and endometrial cancer risk: A systematic review and meta-analysis. Eur J Cancer; 2015; 51(18):2747–2758. CrossRefPubMed
23.
Macaskill P, Walter SD, Irwig L. A comparison of methods to detect publication bias in meta-analysis. Stat Med 2001;20:641–654.CrossRefPubMed
24.
Augustin T, Cagir B, Vandermeer TJ. Characteristic of perforated appendicitis: effect of delay is confounded by age and gender. J Gastrointest Surg 2011;15(7):1223–1231.CrossRefPubMed
25.
Boomer LA, Cooper JN, Deans KJ, Minneci PC, Leonhart K, Diefenbach KA, Kenney BD, Besner GE. Does delay in appendectomy affect surgical site infection in children with appendicitis? J Pediatr Surg 2014;49:1026–1029.CrossRefPubMed
26.
Busch M, Gutzwiller FS, Aellig S, Kuettel R, Metzger U, Zingg U. In-hospital delay increases the risk of perforation in adults with appendicitis. World J Surg 2011;35:1626–1633.CrossRefPubMed
27.
28.
Fahim F, Shirjeel S A comparison between presentation time and delay in surgery in simple and advanced appendicitis. J Ayub Med Coll Abbottabad 2005;17:37–39.PubMed
29.
Gurien LA, Wyrick DL, Smith SD, Dassinger MS. Optimal timing of appendectomy in the pediatric population. J Surg Res 2016;202:126–131.CrossRefPubMed
30.
Hansson LE, Laurell H, Gunnarsson U. Impact of time in the development of acute appendicitis. Dig Surg 2008;25:394–399.CrossRefPubMed
31.
Jeon BG, Kim HJ, Jung KH, Lim HI, Kim SW, Park JS, Kim KH, Kim ID. Appendectomy: Should it Be Performed So Quickly? Am Surg 2016;82:65–74.PubMed
32.
Kim HK, Kim YS, Lee SH, Lee HH. Impact of a delayed laparoscopic appendectomy on the risk of complications in acute appendicitis: a retrospective study of 4,065 patients. Dig Surg 2017;34:25–29.CrossRefPubMed
33.
34.
Mandeville K, Monuteaux M, Pottker T, Bulloch B. Effects of timing to diagnosis and appendectomy in pediatric appendicitis. Pediatr Emerg Care 2015;31:753–758.CrossRefPubMed
35.
Maroju NK, Robinson Smile S, Sistla SC, Narasimhan R, Sahai A. Delay in surgery for acute appendicitis. Anz J Surg 2004;74:773–776.CrossRefPubMed
36.
Sammalkorpi HE, Leppäniemi A, Mentula P. high admission C-reactive protein level and longer in-hospital delay to surgery are associated with increased risk of complicated appendicitis. Langenbecks Arch Surg 2015;400:221–228.CrossRefPubMed
37.
Saar S, Talving P, Laos J, Põdramägi T, Sokirjanski M, Lustenberger T, Lam L, Lepner U. Delay between onset of symptoms and surgery in acute appendicitis increases perioperative morbidity: a prospective study. World J Surg 2016;40:1308–1314.CrossRefPubMed
38.
Yardeni D, Hirschl RB, Drongowski RA, Teitelbaum DH, Geiger JD, Coran AG. Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night? J Pediatr Surg 2004;39:464–469.CrossRefPubMed
39.
Stevenson MD, Dayan PS, Dudley NC, Bajaj L, Macias CG, Bachur RG, Sinclair K, Bennett J, Mittal MK, Donneyong MM, Kharbanda AB; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Time From Emergency department evaluation to operation and appendiceal perforation. Pediatrics 2017;139: e20160742.CrossRefPubMed
40.
United Kingdom National Surgical Research Collaborative, Bhangu A Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis. Ann Surg 2014;259:894–903.
41.
Prystowsky JB, Pugh CM, Nagle AP. Current problems in surgery Appendicitis. Curr Probl Surg 2005;42:688–742.CrossRefPubMed
42.
Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg 2007;31:86–92.CrossRefPubMed
43.
Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, Tuominen R, Hurme S, Virtanen J, Mecklin JP, Sand J, Jartti A, Rinta-Kiikka I, Grönroos JM. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: The APPAC Randomized Clinical Trial. JAMA 2015;313:2340–2348.CrossRefPubMed
44.
Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE,Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R,Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ,Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 2016;11:34.CrossRefPubMedPubMedCentral
45.
Andersson RE. Does delay of diagnosis and treatment in appendicitis cause perforation? World J Surg 2016;40:1315–1317.CrossRefPubMed
46.
Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015; 386(10000):1278–1287.CrossRefPubMed
47.
Di Saverio S, Sibilio A, Giorgini E, Biscardi A, Villani S, Coccolini F, Smerieri N, Pisano M, Ansaloni L, Sartelli M, Catena F, Tugnoli G. The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Ann Surg 2014;260:109–117.CrossRefPubMed
48.
Flum DR. Clinical practice. Acute appendicitis-appendectomy or the “antibiotics first” strategy. N Engl J Med 2015;372:1937–1943.CrossRefPubMed
49.
Nagaraja V, Eslick GD, Cox MR. The acute surgery unite model versus the traditional “on call” model: a systematic review and meta-analysis. World J Surg 2014;38:1381–1387CrossRefPubMed
Metadata
Title
Effect of Delay to Operation on Outcomes in Patients with Acute Appendicitis: a Systematic Review and Meta-analysis
Authors
Jian Li
Run Xu
Deng-Min Hu
Yao Zhang
Tu-Ping Gong
Xue-Lian Wu
Publication date
01-01-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 1/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-3866-y

Other articles of this Issue 1/2019

Journal of Gastrointestinal Surgery 1/2019 Go to the issue

2017 SSAT Plenary Presentation

Multivisceral Resection for Locally Advanced Gastric and Gastroesophageal Junction Cancers—11-Year Experience at a High-Volume North American Center

Multimedia Article

EUS-Guided Antegrade Biliary Stenting Using a Novel Fully Covered Metal Stent (with Video)

2018 SSAT Plenary Presentation

Self-Expanding Metal Stents Versus Endoscopic Vacuum Therapy in Anastomotic Leak Treatment After Oncologic Gastroesophageal Surgery

2018 SSAT Plenary Presentation

A Thousand and One Laparoscopic Heller Myotomies for Esophageal Achalasia: a 25-Year Experience at a Single Tertiary Center

GI Image

Serous Pancreatic Cystadenoma with Compression of Wirsung’s Duct

2018 SSAT Plenary Presentation

Outcome of Patients with Borderline Resectable Pancreatic Cancer in the Contemporary Era of Neoadjuvant Chemotherapy