0
Correspondence |

Delayed Appendectomy

M. Badruddoja, MD, FRCS, FRACS
Arch Surg. 2011;146(5):632-633. doi:10.1001/archsurg.2011.88.
Text Size: A A A
Published online

Extract

The article published by Ingraham et al1 in the September 2010 issue of Archives of Surgery is a large retrospective cohort study with a prospective view on the national level regarding the timing of appendectomy in acute appendicitis. Two studies2,3 from 2 comparable teaching institutions, one for and the other against early appendectomy, have been published in the past. The national study by Ingraham et al1 shows that, in spite of previous publications regarding delaying appendectomy for 12 to 24 hours, 75.2% of patients had an urgent appendectomy within 6 hours after presentation in the emergency department. Current and previous studies show that the results of delayed and urgent appendectomies are the same. Therefore, the benefits of avoiding urgent appendectomies would be that of cost containment, and that surgeons and/or trainees would not lose sleep and thus perform better during regular hours. The study by Ingraham et al1 shows that the mean length of stay is 1.8 days for patients who have had an appendectomy less than 12 hours after diagnosis and 2.19 days for patients who have had an appendectomy more than 12 hours after diagnosis. Patients who have had an uncomplicated appendectomy, by either an open or laparoscopic approach, can be discharged within 24 hours. Therefore, a delayed appendectomy is not at all cost-effective. Currently, in level I and level II trauma centers in the United States, trauma teams work around-the-clock and perform all types of acute emergency surgery.4 Therefore, the attending surgeon, the trainee, and the operating room crew need not report to the hospital to perform an urgent appendectomy. In small community hospitals, the members of a surgical team live only a stone's throw away from the hospital, and it is no trouble for them to come to the hospital in the middle of the night to perform an urgent appendectomy. After all, the old dictum is that acute appendicitis is a surgical emergency. Acute appendicitis is the most common type of emergency surgery, especially in pediatric patients.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination
Make the Diagnosis: Appendicitis, Child

The Rational Clinical Examination
Original Article: Does This Child Have Appendicitis?

brightcove.createExperiences();