Delaying an Appendectomy: Is it Safe?
Delaying an Appendectomy: Is it Safe?
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推迟阑尾切除术：安全吗？
DOI：
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
D. Farkas
中科院分区：
文献类型：
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作者：
K. Nagpal;Navalkishor R. Udgiri;Niraj Sharma;E. Curras;J. Cosgrove;D. Farkas
阑尾炎一直是紧急手术的指征，因为延迟被认为会导致疾病进展，从而导致更糟糕的结果。最近的研究表明，阑尾切除术可以稍微延迟，而不会有更坏的结果，但文献是矛盾的。我们研究的目的是检查手术延迟与患者结局之间的关系。我们回顾了2009年1月至2010年12月在我们机构接受阑尾切除术的所有患者。我们记录了从手术咨询和CT扫描（如果完成）完成时起的手术诊断时间。测量从手术诊断到切口的延迟，并将患者分为两组：早期（延迟≤6小时）和晚期（延迟>6小时）。结果指标为30天并发症发生率、住院时间、穿孔率和腹腔镜转开腹率。377例患者在研究期间接受了阑尾切除术，根据排除标准排除了35例患者，研究中留下342例患者：早期组269例（78.7%），晚期组73例（21.3%）。21例患者（6.1%）发生并发症，两组之间无差异：早期组16/253例（5.9%），晚期组5/73例（6.8%）（P = 0.93，χ2）。早期组的平均（±标准差）住院时间为86.1 ± 67.1小时，晚期组为95.9 ± 73.0小时。该差异不显著（P = 0.22）。延迟阑尾切除术超过6小时，但从诊断不到24小时是安全的，不会导致更糟糕的结果。这可以帮助限制对外科医生和手术室的时间表的干扰。
Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The goal of our study was to examine the relationship between this delay to surgery and patient outcomes. We reviewed all patients that underwent an appendectomy in our institution from January 2009 to December 2010. We recorded the time of surgical diagnosis from when both the surgical consult and the CT scan (if done) were completed. The delay from surgical diagnosis to incision was measured, and patients were divided into two groups: early (≤6 hours delay) and late (>6 hours delay). Outcome measures were 30-day complication rate, length of stay, perforation rate, and laparoscopic to open conversion rate. Three hundred and seventy-seven patients had appendectomies in the study period, and 35 patients were excluded as per the exclusion criteria leaving 342 in the study: 269 (78.7%) in the early group and 73 (21.3%) in the late group. Complications occurred in 21 patients (6.1%) with no difference between the groups: 16/253 (5.9%) in the early group and 5/73 (6.8%) in the late group (P = 0.93, χ2). The mean (± standard deviation) length of stay was 86.1 ± 67.1 hours in the early group, and 95.9 ± 73.0 hours in the late group. This difference was not significant (P = 0.22). Delaying an appendectomy more than 6 hours, but less than 24 hours from diagnosis is safe and does not lead to worse outcomes. This can help limit the disruption to the schedules of both the surgeon and the operating room.