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In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Present theory is that uncomplicated and complicated appendicitis are different entities. Recent studies suggest it is safe to delay surgery in patients with uncomplicated appendicitis. We hypothesize that patients with complicated appendicitis are at higher risk for postoperative complications when surgery is delayed.

Methods

Data was used from the multicenter, prospective SNAPSHOT appendicitis study of 1975 patients undergoing surgery for suspected appendicitis. Adult patients (≥ 18 years) who underwent appendectomy for appendicitis were included in this study. The primary outcome was the difference in postoperative complications between patients with complicated appendicitis who were operated within and after 8 h after hospital presentation. Secondary outcomes were the incidence of both uncomplicated and complicated appendicitis in relationship to delay of appendectomy. Follow-up was 30 days. A multivariable analysis was performed.

Results

Of 1341 adult patients with appendicitis, 34.3% had complicated appendicitis. In patients with complicated appendicitis, 22.8% developed a postoperative complication compared to 8.2% for uncomplicated appendicitis (P < 0.001). Delay in surgery (> 8 h) increased the complication rate in patients with complicated appendicitis (28.1%) compared to surgery within 8 h (18.3%; P = 0.01). Multivariate analysis showed a delay in surgery as an independent predictor for a postoperative complication in patients with complicated appendicitis (OR 1.71; 95%CI 1.01–2.68, P = 0.02).

Conclusion

In-hospital delay of surgery (> 8 h) in patients with complicated appendicitis is associated with a higher risk of a postoperative complication. It is important that we recognize and treat these patients early.

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Acknowledgements

On behalf of the Snapshot Appendicitis Collaborative Study group: Van AckerGJ, Akkermans B, AkkersdijkGJ, Algie GD, Allema JH, Andeweg CS, Appeldoorn N, van Baal JG, den Bakker CM, Bartels SA, van den Berg C, Boekestijn, B, den Boer FC, Boerma D, van den Boom AL, Boute MC, Bouwense SA, Bransen J, van Brussel FA, Busch OR, de Castro SM, Cense HA, Croese, C, van dalen T, Dawson I, van Dessel E, Dettmers R, DharN, Dohmen FY, van Dongen KW, van Duijvendijk P, DulferRR, Dwars BJ, Eerenberg JP, van der Elst M, van den Ende E, Fassaert LM, Fikkers JT, Foppen, JW, Furnee, EJ, Garssen FP, Gerhards MF, van Goor H, de Graaf JS, Graat LJ, Grootr J, van der Ham AC, Hamming JF, Hamminga JT, van der Harst E, Heemskerk J, Heijne A, Heikens JT, Heineman E, Hertogs R, van Heurn E, van den Hil LC, Hooftwijk AG, Hulsker CC, Hunen DR, Ibelings MS, Klaase JM, Klicks R, Knaapen L, Kortekaas RT, Kruyt F, Kwant S, Lases SS, LettingaT, Loupatty A, Matthijsen RA, Minnee RC, Mirck B, Mitalas L, Moes D, Moorman AM, Nieuwenhuijs VB, Nieuwenhuizen GA, Nijk PD, Omloo JM, Ottenhof AG, Palamba HW, van der Peet DL, Pereboom IT, Plaisier PW, van der Ploeg AP, Raber MH, Reijen MM, Rijna H, Rosman C, Roumen RM, Scmitz RF, Schouten van der Velden AP, Scheurs WH, Sigterman TA, Smeets HJ, Sonnevled DJ, Sosef MN, Spoor SF, Stassen LP, van Steensel L, Stortelder E, Straatman J, van Susante HJ, Suykerbuyk de Hoog DE, Terwisscha van Scheltinga C, Toorenvliet BR, Verbeek PC, Verseveld M, Volders JH, Vriens MR, Vriens PW, Vrouenraets BC, van de wall BJ, Wegdam JA, WesterduinE, Wever JJ, Wijfels NA, Wijnhoven BP, Winkel TA, van der Zee DC Zeillemaker AM, Zietse C.

Author information

Authors and Affiliations

  1. Department of Surgery, Dijklander Hospital, Hoorn, The Netherlands

    M. D. M. Bolmers

  2. Department of Surgery, Tergooi Hospital, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands

    M. D. M. Bolmers, J. de Jonge, W. J. Bom & A. A. W. van Geloven

  3. Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands

    C. C. van Rossem

  4. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

    W. A. Bemelman

Authors
  1. M. D. M. Bolmers
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  2. J. de Jonge
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  3. W. J. Bom
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  4. C. C. van Rossem
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  5. A. A. W. van Geloven
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  6. W. A. Bemelman
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Consortia

on behalf of the Snapshot Appendicitis Collaborative Study group

  • G. J. Van Acker
  • , B. Akkermans
  • , G. J. Akkersdijk
  • , G. D. Algie
  • , J. H. Allema
  • , C. S. Andeweg
  • , N. Appeldoorn
  • , J. G. van Baal
  • , C. M. den Bakker
  • , S. A. Bartels
  • , C. van den Berg
  • , B. Boekestijn
  • , F. C. den Boer
  • , D. Boerma
  • , A. L. van den Boom
  • , M. C. Boute
  • , S. A. Bouwense
  • , J. Bransen
  • , F. A. van Brussel
  • , O. R. Busch
  • , S. M. de Castro
  • , H. A. Cense
  • , C. Croese
  • , T. van dalen
  • , I. Dawson
  • , E. van Dessel
  • , R. Dettmers
  • , N. Dhar
  • , F. Y. Dohmen
  • , K. W. van Dongen
  • , P. van Duijvendijk
  • , R. R. Dulfer
  • , B. J. Dwars
  • , J. P. Eerenberg
  • , M. van der Elst
  • , E. van den Ende
  • , L. M. Fassaert
  • , J. T. Fikkers
  • , J. W. Foppen
  • , E. J. Furnee
  • , F. P. Garssen
  • , M. F. Gerhards
  • , H. van Goor
  • , J. S. de Graaf
  • , L. J. Graat
  • , J. Grootr
  • , A. C. van der Ham
  • , J. F. Hamming
  • , J. T. Hamminga
  • , E. van der Harst
  • , J. Heemskerk
  • , A. Heijne
  • , J. T. Heikens
  • , E. Heineman
  • , R. Hertogs
  • , E. van Heurn
  • , L. C. van den Hil
  • , A. G. Hooftwijk
  • , C. C. Hulsker
  • , D. R. Hunen
  • , M. S. Ibelings
  • , J. M. Klaase
  • , R. Klicks
  • , L. Knaapen
  • , R. T. Kortekaas
  • , F. Kruyt
  • , S. Kwant
  • , S. S. Lases
  • , T. Lettinga
  • , A. Loupatty
  • , R. A. Matthijsen
  • , R. C. Minnee
  • , B. Mirck
  • , L. Mitalas
  • , D. Moes
  • , A. M. Moorman
  • , V. B. Nieuwenhuijs
  • , G. A. Nieuwenhuizen
  • , P. D. Nijk
  • , J. M. Omloo
  • , A. G. Ottenhof
  • , H. W. Palamba
  • , D. L. van der Peet
  • , I. T. Pereboom
  • , P. W. Plaisier
  • , A. P. van der Ploeg
  • , M. H. Raber
  • , M. M. Reijen
  • , H. Rijna
  • , C. Rosman
  • , R. M. Roumen
  • , R. F. Scmitz
  • , A. P. Schouten van der Velden
  • , W. H. Scheurs
  • , T. A. Sigterman
  • , H. J. Smeets
  • , D. J. Sonnevled
  • , M. N. Sosef
  • , S. F. Spoor
  • , L. P. Stassen
  • , L. van Steensel
  • , E. Stortelder
  • , J. Straatman
  • , H. J. van Susante
  • , D. E. Suykerbuyk de Hoog
  • , C. Terwisscha van Scheltinga
  • , B. R. Toorenvliet
  • , P. C. Verbeek
  • , M. Verseveld
  • , J. H. Volders
  • , M. R. Vriens
  • , P. W. Vriens
  • , B. C. Vrouenraets
  • , B. J. van de wall
  • , J. A. Wegdam
  • , E. Westerduin
  • , J. J. Wever
  • , N. A. Wijfels
  • , B. P. Wijnhoven
  • , T. A. Winkel
  • , D. C. van der Zee
  • , A. M. Zeillemaker
  •  & C. Zietse

Corresponding author

Correspondence to M. D. M. Bolmers.

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This study was waived from approval by the institutional review board of the Amsterdam UMC.

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Bolmers, M.D.M., de Jonge, J., Bom, W.J. et al. In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis. J Gastrointest Surg 26, 1063–1069 (2022). https://doi.org/10.1007/s11605-021-05220-w

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  • DOI: https://doi.org/10.1007/s11605-021-05220-w

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