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

1. Taylor, M., S. Emil, et al. (2005). "Emergent vs urgent appendectomy in children: a study of outcomes." J Pediatr Surg 40(12): 1912-5.
2. 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.
3. 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.