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Acute Appendicitis – Delayed Surgery option?
- Appendicitis incidence in children = 4/1000
- The traditional emergent surgical intervention has recently been challenged.
- Three RETROSPECTIVE studies investigated delayed/urgent vs emergent surgical interventions
- 2 of the three found no significant difference in perforation or complication rates between the 2 groups.
- 1 found that the emergent group had higher rates of perforation.
- What you need to know:
- surgeons may base their decisions on these studies, which do have limitations (being that their retrospective)
- despite the time of day, you should still advocate for patients that are “sick” to go to the OR rather than get antibiotics to “cool off” first.
References
- Taylor, M., S. Emil, et al. (2005). "Emergent vs urgent appendectomy in children: a study of outcomes." J Pediatr Surg 40(12): 1912-5.
- Yardeni, D., R. B. Hirschl, et al. (2004). "Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night?" J Pediatr Surg 39(3): 464-9; discussion 464-9.
- Surana, R., F. Quinn, et al. (1993). "Is it necessary to perform appendicectomy in the middle of the night in children?" Bmj 306(6886): 1168.