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Acute Appendicitis in the Twenty-First Century: Should We Modify the Management Protocol?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Recent data challenge the traditional management of acute appendicitis with early surgical intervention. This study evaluated the impact of timing of appendectomy and other potential risk factors on progression of acute appendicitis.

Study Design

A search of the relevant databases of a tertiary medical center identified 1,604 patients with verified acute appendicitis who underwent appendectomy in 2004–2007. Demographic and clinical data and time from symptom onset to emergency room admission (“patient interval”) and from emergency room admission to surgery (“hospital interval”) and their combination were analyzed by pathological grade.

Results

On multivariate analyses, independent risk factors for appendiceal perforation were age <20 years (OR = 1.58, 95 % CI 1.07–2.35) or >50 years (OR = 2.84, 95 % CI 1.82–4.45) (relative to 20–50 years), white cell count >10 × 103/mm3 (OR = 4.45, 95 % CI 2.05–9.67), body temperature >37.8 °C (OR = 2.23, 95 % CI 1.45–3.41), hospital interval >24 h (OR = 2.84, 95 % CI 1.49–5.4), patient interval >48 h (OR = 3.84, 95 % CI 2.35–6.29), and combined interval >48 h (OR = 4.29, 95 % CI 2.2–8.36). No association with perforation was found for the hour of emergency room arrival, hour of operation, surgical approach, or the performance of preoperative imaging.

Conclusions

In the general population, the risk of advanced pathological grade of appendicitis increases with time. Thus, prompt appendectomy is warranted. Prospective studies of subgroups of perforated and nonperforated appendicitis are needed.

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Authors and Affiliations

  1. Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach-Tiqva, 49100, Israel

    Eran Sadot, Nir Wasserberg & Andrei Keidar

  2. Department of Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Ron Shapiro

  3. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Eran Sadot, Nir Wasserberg, Ron Shapiro, Andrei Keidar, Bernice Oberman & Siegal Sadetzki

  4. Cancer and Radiation Epidemiology Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Bernice Oberman & Siegal Sadetzki

Authors
  1. Eran Sadot
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  2. Nir Wasserberg
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  3. Ron Shapiro
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  4. Andrei Keidar
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  5. Bernice Oberman
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  6. Siegal Sadetzki
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Correspondence to Eran Sadot.

Additional information

This study was presented at the American College of Surgeons 96th Annual Clinical Congress, Washington, DC, October 3–7, 2010.

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Sadot, E., Wasserberg, N., Shapiro, R. et al. Acute Appendicitis in the Twenty-First Century: Should We Modify the Management Protocol?. J Gastrointest Surg 17, 1462–1470 (2013). https://doi.org/10.1007/s11605-013-2232-3

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  • DOI: https://doi.org/10.1007/s11605-013-2232-3

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