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 language | English (US) |
|---|---|
| Pages (from-to) | 886-892 |
| Number of pages | 7 |
| Journal | Archives of Surgery |
| Volume | 145 |
| Issue number | 9 |
| DOIs | |
| State | Published - Jan 1 2010 |
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ASJC Scopus subject areas
- Surgery
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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 journal › Article
TY - JOUR
T1 - Effect of delay to operation on outcomes in adults with acute appendicitis
AU - Ingraham, Angela M.
AU - Cohen, Mark E.
AU - Bilimoria, Karl Y
AU - Ko, Clifford Y.
AU - Hall, Bruce L.
AU - Russell, Thomas R.
AU - Nathens, Avery B.
PY - 2010/1/1
Y1 - 2010/1/1
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.
UR - http://www.scopus.com/inward/record.url?scp=77957033338&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77957033338&partnerID=8YFLogxK
U2 - 10.1001/archsurg.2010.184
DO - 10.1001/archsurg.2010.184
M3 - Article
C2 - 20855760
AN - SCOPUS:77957033338
VL - 145
SP - 886
EP - 892
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 9
ER -