Effect of delay to operation on outcomes in adults with acute appendicitis

Angela M. Ingraham, Mark E. Cohen, Karl Y Bilimoria, Clifford Y. Ko, Bruce L. Hall, Thomas R. Russell, Avery B. Nathens

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Objective: To examine the effect of delay from surgical admission to induction of anesthesia on outcomes after appendectomy for acute appendicitis in adults. Design: Retrospective cohort study with the principal exposure being time to operation. Regression models yielded probabilities of outcomes adjusted for patient and operative risk factors. Setting: Data were submitted to the American College of Surgeons National Surgical Quality Improvement Program database from January 1, 2005, through December 31, 2008. Patients: Patients with acute appendicitis who underwent an appendectomy. Main Outcome Measures: Thirty-day overall morbidity and serious morbidity/mortality. Results: Of 32 782 patients, 24 647 (75.2%) underwent operations within 6 hours of surgical admission, 4934 (15.1%) underwent operations more than 6 through 12 hours, and 3201 (9.8%) underwent operations more than 12 hours after surgical admission. Differences in operative duration (51, 50, and 55 minutes, respectively; P < .001) were statistically significant but not clinically meaningful. The length of postoperative stay (2.2 days for the >12-hour group vs 1.8 days for the remaining groups; P < .001) was statistically significant but not clinically meaningful. No significant differences were found in adjusted overall morbidity (5.5%, 5.4%, and 6.1%, respectively; P = .33) or serious morbidity/mortality (3.0%, 3.6%, and 3.0%, respectively; P = .17). Duration from surgical admission to induction of anesthesia was not predictive in regression models for overall morbidity or serious morbidity/mortality. Conclusions: In this retrospective study, delay of appendectomy for acute appendicitis in adults does not appear to adversely affect 30-day outcomes. This information can guide the use of potentially limited operative and professional resources allocated for emergency care.

Original languageEnglish (US)
Pages (from-to)886-892
Number of pages7
JournalArchives of Surgery
Volume145
Issue number9
DOIs
StatePublished - Jan 1 2010

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Appendicitis
Morbidity
Appendectomy
Mortality
Anesthesia
Retrospective Studies
Emergency Medical Services
Quality Improvement
Cohort Studies
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Ingraham, A. M., Cohen, M. E., Bilimoria, K. Y., Ko, C. Y., Hall, B. L., Russell, T. R., & Nathens, A. B. (2010). Effect of delay to operation on outcomes in adults with acute appendicitis. Archives of Surgery, 145(9), 886-892. https://doi.org/10.1001/archsurg.2010.184
Ingraham, Angela M. ; Cohen, Mark E. ; Bilimoria, Karl Y ; Ko, Clifford Y. ; Hall, Bruce L. ; Russell, Thomas R. ; Nathens, Avery B. / Effect of delay to operation on outcomes in adults with acute appendicitis. In: Archives of Surgery. 2010 ; Vol. 145, No. 9. pp. 886-892.
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abstract = "Objective: To examine the effect of delay from surgical admission to induction of anesthesia on outcomes after appendectomy for acute appendicitis in adults. Design: Retrospective cohort study with the principal exposure being time to operation. Regression models yielded probabilities of outcomes adjusted for patient and operative risk factors. Setting: Data were submitted to the American College of Surgeons National Surgical Quality Improvement Program database from January 1, 2005, through December 31, 2008. Patients: Patients with acute appendicitis who underwent an appendectomy. Main Outcome Measures: Thirty-day overall morbidity and serious morbidity/mortality. Results: Of 32 782 patients, 24 647 (75.2{\%}) underwent operations within 6 hours of surgical admission, 4934 (15.1{\%}) underwent operations more than 6 through 12 hours, and 3201 (9.8{\%}) underwent operations more than 12 hours after surgical admission. Differences in operative duration (51, 50, and 55 minutes, respectively; P < .001) were statistically significant but not clinically meaningful. The length of postoperative stay (2.2 days for the >12-hour group vs 1.8 days for the remaining groups; P < .001) was statistically significant but not clinically meaningful. No significant differences were found in adjusted overall morbidity (5.5{\%}, 5.4{\%}, and 6.1{\%}, respectively; P = .33) or serious morbidity/mortality (3.0{\%}, 3.6{\%}, and 3.0{\%}, respectively; P = .17). Duration from surgical admission to induction of anesthesia was not predictive in regression models for overall morbidity or serious morbidity/mortality. Conclusions: In this retrospective study, delay of appendectomy for acute appendicitis in adults does not appear to adversely affect 30-day outcomes. This information can guide the use of potentially limited operative and professional resources allocated for emergency care.",
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Ingraham, AM, Cohen, ME, Bilimoria, KY, Ko, CY, Hall, BL, Russell, TR & Nathens, AB 2010, 'Effect of delay to operation on outcomes in adults with acute appendicitis', Archives of Surgery, vol. 145, no. 9, pp. 886-892. https://doi.org/10.1001/archsurg.2010.184

Effect of delay to operation on outcomes in adults with acute appendicitis. / Ingraham, Angela M.; Cohen, Mark E.; Bilimoria, Karl Y; Ko, Clifford Y.; Hall, Bruce L.; Russell, Thomas R.; Nathens, Avery B.

In: Archives of Surgery, Vol. 145, No. 9, 01.01.2010, p. 886-892.

Research output: Contribution to journalArticle

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AU - Cohen, Mark E.

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AU - Russell, Thomas R.

AU - Nathens, Avery B.

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N2 - Objective: To examine the effect of delay from surgical admission to induction of anesthesia on outcomes after appendectomy for acute appendicitis in adults. Design: Retrospective cohort study with the principal exposure being time to operation. Regression models yielded probabilities of outcomes adjusted for patient and operative risk factors. Setting: Data were submitted to the American College of Surgeons National Surgical Quality Improvement Program database from January 1, 2005, through December 31, 2008. Patients: Patients with acute appendicitis who underwent an appendectomy. Main Outcome Measures: Thirty-day overall morbidity and serious morbidity/mortality. Results: Of 32 782 patients, 24 647 (75.2%) underwent operations within 6 hours of surgical admission, 4934 (15.1%) underwent operations more than 6 through 12 hours, and 3201 (9.8%) underwent operations more than 12 hours after surgical admission. Differences in operative duration (51, 50, and 55 minutes, respectively; P < .001) were statistically significant but not clinically meaningful. The length of postoperative stay (2.2 days for the >12-hour group vs 1.8 days for the remaining groups; P < .001) was statistically significant but not clinically meaningful. No significant differences were found in adjusted overall morbidity (5.5%, 5.4%, and 6.1%, respectively; P = .33) or serious morbidity/mortality (3.0%, 3.6%, and 3.0%, respectively; P = .17). Duration from surgical admission to induction of anesthesia was not predictive in regression models for overall morbidity or serious morbidity/mortality. Conclusions: In this retrospective study, delay of appendectomy for acute appendicitis in adults does not appear to adversely affect 30-day outcomes. This information can guide the use of potentially limited operative and professional resources allocated for emergency care.

AB - Objective: To examine the effect of delay from surgical admission to induction of anesthesia on outcomes after appendectomy for acute appendicitis in adults. Design: Retrospective cohort study with the principal exposure being time to operation. Regression models yielded probabilities of outcomes adjusted for patient and operative risk factors. Setting: Data were submitted to the American College of Surgeons National Surgical Quality Improvement Program database from January 1, 2005, through December 31, 2008. Patients: Patients with acute appendicitis who underwent an appendectomy. Main Outcome Measures: Thirty-day overall morbidity and serious morbidity/mortality. Results: Of 32 782 patients, 24 647 (75.2%) underwent operations within 6 hours of surgical admission, 4934 (15.1%) underwent operations more than 6 through 12 hours, and 3201 (9.8%) underwent operations more than 12 hours after surgical admission. Differences in operative duration (51, 50, and 55 minutes, respectively; P < .001) were statistically significant but not clinically meaningful. The length of postoperative stay (2.2 days for the >12-hour group vs 1.8 days for the remaining groups; P < .001) was statistically significant but not clinically meaningful. No significant differences were found in adjusted overall morbidity (5.5%, 5.4%, and 6.1%, respectively; P = .33) or serious morbidity/mortality (3.0%, 3.6%, and 3.0%, respectively; P = .17). Duration from surgical admission to induction of anesthesia was not predictive in regression models for overall morbidity or serious morbidity/mortality. Conclusions: In this retrospective study, delay of appendectomy for acute appendicitis in adults does not appear to adversely affect 30-day outcomes. This information can guide the use of potentially limited operative and professional resources allocated for emergency care.

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