Safety of Short, In-Hospital Delays Before Surgery for Acute Appendicitis

被引：17

作者：

Bhangu, Aneel ^{[1
]}

Singh, Prashant

Panagiotopoulou, I. G. ^{[2
]}

Chatzizacharias, N. ^{[2
]}

Rana, M. ^{[2
]}

Rollins, K. ^{[2
]}

Ejtehadi, F. ^{[2
]}

Jha, B. ^{[2
]}

Tan, Y. W. ^{[2
]}

Fanous, N. ^{[2
]}

Markides, G. ^{[3
]}

Tan, A. ^{[3
]}

Marshal, C. ^{[3
]}

Akhtar, S. ^{[3
]}

Mullassery, D. ^{[4
]}

Ismail, A. ^{[5
]}

Hitchins, C. ^{[6
,7
]}

Sharif, S. ^{[8
]}

Osborne, L. ^{[8
]}

Sengupta, N. ^{[9
]}

Challand, C. ^{[9
]}

Pournaras, D. ^{[9
]}

Bevan, K. ^{[9
]}

King, J. ^{[10
]}

Massey, J. ^{[11
]}

Sandhu, I. ^{[11
]}

Wells, J. M. ^{[12
]}

Teichmann, D. A. ^{[12
]}

Peckham-Cooper, A. ^{[13
]}

Sellers, M. ^{[13
]}

Folaranmi, S. E. ^{[14
]}

Davies, B. ^{[14
]}

Potter, S. ^{[15
]}

Egbeare, D. ^{[15
]}

Kallaway, C. ^{[15
]}

Parsons, S. ^{[15
]}

Upchurch, E. ^{[15
]}

Lazaridis, A. ^{[16
]}

Cocker, D. ^{[16
]}

King, D. ^{[16
]}

Behar, N. ^{[16
]}

Loukogeorgakis, S. P. ^{[17
]}

Kalaiselvan, R. ^{[18
]}

Marzouk, S. ^{[19
]}

Turner, E. J. H. ^{[19
]}

Kaptanis, S. ^{[19
]}

Kaur, V. ^{[19
]}

Shingler, G. ^{[20
]}

Bennett, A. ^{[20
]}

Shaikh, S. ^{[21
]}

机构：

[1] Queen Elizabeth Hosp, Acad Dept Surg, West Midlands Res Collaborat, Birmingham B15 2TH, W Midlands, England

[2] Addenbrookes Hosp, Cambridge, England

[3] Airedale NHS Fdn Trust, Keighley, England

[4] Alder Hey Childrens Hosp Fdn Trust, Liverpool, Merseyside, England

[5] Alexandra Hosp, Redditch, England

[6] Ashford Hosp, Ashford, Kent, England

[7] St Peters Hosp, Chertsey, England

[8] Barts Hlth NHS Trust, London, England

[9] Bedford Hosp NHS Trust, Bedford, England

[10] Birmingham Childrens Hosp, Birmingham, W Midlands, England

[11] Bradford Teaching Hosp NHS Fdn Trust, Bradford, W Yorkshire, England

[12] Bristol Royal Hosp Children, Bristol, Avon, England

[13] Burton Hosp NHS Fdn Trust, Burton Upon Trent, England

[14] Cent Manchester Univ Hosp NHS Fdn Trust, Manchester, Lancs, England

[15] Cheltenham Gen Hosp, Cheltenham, Glos, England

[16] Chelsea & Westminster Teaching Hosp, London, England

[17] Chelsea & Westminster Hosp NHS Fdn Trust, London Paediat Surg, London, England

[18] Countess Chester NHS Fdn Trust, Chester, Cheshire, England

[19] Croydon Univ Hosp, Surrey, England

[20] Royal Glamorgan Hosp, Llantrisant, Wales

[21] Dewsbury Dist Hosp, Dewsbury, England

[22] Princess Wales Hosp, Grimsby, Wales

[23] East Cheshire NHS Trust, Macclesfield, Cheshire, England

[24] Eastbourne Dist Gen Hosp, Eastbourne, England

[25] Guys & St Thomas NHS Fdn Trust, Evelina Childrens Hosp, London, England

[26] North Bristol NHS Trust, Frenchay Hosp, Bristol, Avon, England

[27] Gloucester Royal Hosp, Gloucester, England

[28] Good Hope Hosp, Sutton Coldfield, England

[29] Great Ormond St Hosp NHS Fdn Trust, London, England

[30] Great Western Hosp, Swindon, Wilts, England

[31] Harrogate & Dist NHS Fdn Trust, Harrogate, England

[32] Heartlands Hosp, Birmingham, W Midlands, England

[33] Hinchingbrooke Hlth Care NHS Trust, Huntingdon, Cambs, England

[34] Hosp San Bernabe, Berga, Spain

[35] Hosp Santos Reyes, Aranda De Duero, Spain

[36] Hull & East Yorkshire Hosp NHS Trust, Kingston Upon Hull, N Humberside, England

[37] Hull & East Yorkshire Hosp NHS Trust Paediat Surg, Kingston Upon Hull, N Humberside, England

[38] Ipswich Hosp NHS Trust, Ipswich, Suffolk, England

[39] King George Hosp, Ilford, England

[40] Kings Coll Hosp London, London SE5 8RX, England

[41] Kings Mill Hosp, Mansfield, PA USA

[42] Leeds Teaching Hosp NHS Trust, Leeds, W Yorkshire, England

[43] Leeds Teaching Hosp NHS Trust Paediat Surg, Leeds, W Yorkshire, England

[44] Leicester Royal Infirm, Leicester, Leics, England

[45] Lincoln Cty Hosp, Lincoln, England

[46] Maidstone & Tunbridge Wells NHS Trust, Maidstone, Kent, England

[47] Manor Hosp, Walsall, W Midlands, England

[48] Musgrove Pk Hosp, Taunton, England

[49] Natl Ctr Global Hlth & Med, Tokyo, Japan

[50] Newham Univ Hosp, London, England

来源：

ANNALS OF SURGERY | 2014年 / 259卷 / 05期

关键词：

appendicectomy; appendicitis; surgical outcomes; timing of surgery; APPENDECTOMY; ADULTS; PERFORATION; OUTCOMES; RISK; INFECTION; INCREASES;

D O I：

10.1097/SLA.0000000000000492

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: To determine safety of short in-hospital delays before appendicectomy. Background: Short organizational delays before appendicectomy may safely improve provision of acute surgical services. Methods: The primary endpoint was the rate of complex appendicitis (perforation, gangrene, and/or abscess). The main explanatory variable was timing of surgery, using less than 12 hours from admission as the reference. The first part of this study analyzed primary data from a multicentre study on appendicectomy from 95 centers. The second part combined this data with a systematic review and meta-analysis of published data. Results: The cohort study included 2510 patients with acute appendicitis, of whom 812 (32.4%) had complex findings. Adjusted multivariable binary regression modelling showed that timing of operation was not related to risk of complex appendicitis [12-24 hours odds ratio (OR) 0.98 (P = 0.869); 24-48 hours OR 0.88 (P = 0.329); 48+ hours OR 0.82 (P = 0.317)]. However, after 48 hours, the risk of surgical site infection and 30-day adverse events both increased [adjusted ORs 2.24 (P = 0.039) and 1.71 (P = 0.024), respectively]. Meta-analysis of 11 nonrandomized studies (8858 patients) revealed that delay of 12 to 24 hours after admission did not increase the risk of complex appendicitis (OR 0.97, P = 0.750). Conclusions: Short delays of less than 24 hours before appendicectomy were not associated with increased rates of complex pathology in selected patients. These organizational delays may aid service provision, but planned delay beyond this should be avoided. However, where optimal surgical systems allow for expeditious surgery, prompt appendicectomy will still aid fastest resolution of pain for the individual patient.

引用

页码：894 / 903

页数：10

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