Delay of surgery in acute appendicitis**

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Background and Objectives

It is generally assumed that delayed diagnosis of acute appendicitis results in higher morbidity but this assumption is not strongly supported in the literature. We attempt to define the effect of patient and physician delay on the outcome of patients with acute appendicitis.

Patients and Methods

We studied 486 patients admitted between 1980 and 1992. Patient delay in presenting to a physician and surgeon delay from hospital admission to operation were studied in relation to stage of disease at operation as well as to postoperative complications.

Results

Postoperative complications occurred in 10% of cases with simple acute appendicitis versus about 20% of cases with gangrenous or perforated appendicitis (P < 0.001). The mean patient delay from onset of symptoms to presentation to a physician was 1.7 days in simple acute appendicitis versus 2.3 days in gangrenous or perforated appendicitis (P < 0.001). Mean surgeon delay was 13.6 hours in simple acute appendicitis versus 14.5 hours in advanced appendicitis (P = NS).

Conclusion

Delay in patient presentation adversely affects the stage of disease in acute appendicitis and leads to increased incidence of infectious complications and to prolonged hospital stay. Conversely, physician delay does not affect the stage of disease. A surgeon's decision to observe patients in hospital in order to clarify the diagnosis is justified, as it does not adversely affect outcome.

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  • Cited by (144)

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      2018, Journal of the American College of Surgeons
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      To date, few data have been published examining the relationship of TTA and OD on hospital cost and cost variation among hospitals. Earlier studies examining treatment delay and outcomes have focused largely on the risk of complicated appendicitis developing,9-25 with only a few studies considering cost and resource use end points.26-28 In a single-center study of 453 children undergoing appendectomy for appendicitis by Dhupar and colleagues,28 delay longer than 2 hours between case booking and incision was associated with a 39% increase in hospital cost.

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    **

    This is still much to be learned from this imperfect clinical diagnosis of appendicitis that is not necessarily technology dependent. This report from Israel indicates that patient delay is a more serious factor than physician delay.

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