Introduction: Acute appendicitis (AA) is the most frequent surgical condition of the abdomen during childhood. Its clinical presentation in children under 5 may be atypical and thus causes a delay in diagnosis, which often leads to complications such as perforation and peritonitis. Patients with unperforated AA at hospital admission may have their surgery postponed up to 24 hours while antibiotics are initiated without significant increase in complications, instead of undergoing immediate surgery. Immediate surgery to prevent complications has been questioned. Delaying surgery in patients admitted to hospital with AA has not increased the risk of perforation. Objective: To determine the impact of timing of surgery of patients with AA admitted to our Pediatric Surgery Ward of the Sorocaba Hospital Complex of the Medical Science and Health Faculty (CHS-PUC/SP) on the rate of complications (perforation, peritoneal drainage and infection of the surgical wound). Methods: We reviewed the records of 195 children aged 4 to 12 years, admitted between 2010 and 2014. They were separated in 2 groups according to timing of surgery under 7 hours (group A) and 7 to 24 hours (group B) and had their rate of complications (infection of the surgical wound, drainage and perforation (grade IV) assessed. Results: Ninety-seven children underwent surgery less than 7 hours after admission (group A) and 98 children were operated between 7 and 24 hours after admission (group B). Groups A and B had no significant difference regarding the rates of wound infection (p = 0.2277), peritoneal drain insertion (p = 0.4085) or perforation (p = 0.7125). Conclusions: In our study, timing of surgery for AA had no impact on the occurrence of complications, such as infection of the surgical wound, peritoneal drainage or perforation.
References
[1]
Morrow, S.E. and Newman, K.D. (2007) Current Management of Appendicitis. Seminars in Pediatric Surgery, 16, 34-40.
https://doi.org/10.1053/j.sempedsurg.2006.10.005
[2]
Lund, D.P. and Murphy, E.U. (1994) Management of Perforated Appendicitis in Children: A Decade of Aggressive Treatment. Journal of Pediatric Surgery, 29, 1130-1134. https://doi.org/10.1016/0022-3468(94)90294-1
[3]
Nadler, E.P., Reblock, K.K., Ford, H.R. and Gaines, B.A. (2003) Monotherapy versus Multi-Drug Therapy for the Treatment of Perforated Appendicitis in Children. Surgical Infections, 4, 327-333. https://doi.org/10.1089/109629603322761382
[4]
Pérez-Martinez, A., Conde-Cortés, J., Matínez-Bermeio, M.A., Bento-Bravo, L., Busto-Aguirreureta, N. and Goni-Orayen, C. (2005) Programmed Surgery for Acute Appendicitis. Cirugía Pediátrica, 18, 109-112.
[5]
Henry, M.C., Gollin, G., Islam, S., Sylvester, K., Walker, A., Silverman, B.L. and Moss, R.L. (2007) Matched Analysis of Nonoperative Management vs Immediate Appendectomy for Perforated Appendicitis. Journal of Pediatric Surgery, 42, 19-24.
https://doi.org/10.1016/j.jpedsurg.2006.09.005
[6]
Yardeni, D., Hirschl, R.B., Drongowski, R.A., Teitelbaum, D.H., Geiger, J.D. and Coran, A.G. (2004) Delayed versus Immediate Surgery in Acute Appendicitis: Do We Need to Operate during the Night? Journal of Pediatric Surgery, 39, 464-469.
https://doi.org/10.1016/j.jpedsurg.2003.11.020
[7]
Teixceira, P.G., Sivrikoz, E., Inaba, K., Talving, P., Lam, L. and Demetriades, D. (2012) Appendectomy Timing. Annals of Surgery, 256, 538-543.
https://doi.org/10.1097/SLA.0b013e318265ea13
[8]
Kearney, D., Cahill, R.A., O’Brien, E., Kirwan, W.O. and Redmond, H.P. (2008) Influence of Delays on Perforation Risk in Adults with Acute Appendicitis. Diseases of the Colon & Rectum, 51, 1823-1827. https://doi.org/10.1007/s10350-008-9373-6
[9]
Serres, S.K., Cameron, D.B., Glass, C.C., Graham, D.A., Zurakowski, D., Karki, M., Anandalwar, S. and Rangel, S.J. (2017) Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children. JAMA Pediatrics, 171, 740-747. https://doi.org/10.1001/jamapediatrics.2017.0885
[10]
Boomer, L.A., Cooper, J.N., Deans, K.J., Minneci, P.C., Leonhart, K., Diefenbach, K.A., Kenney, B.D. and Besner, G.E. (2014) Does Delay in Appendectomy Affect Surgical Site Infection in Children with Appendicitis? Journal of Pediatric Surgery, 49, 1026-1029. https://doi.org/10.1016/j.jpedsurg.2014.01.044
[11]
Boomer, L.A., Cooper, J.N., Anadalwar, S., Fallon, S.C., Ostlie, D., Leys, C.M., Minneci, P.C., et al. (2016) Delaying Appendectomy Does Not Lead to Higher Rates of Surgical Site Infections. Annals of Surgery, 264, 164-168.
https://doi.org/10.1097/SLA.0000000000001396
[12]
Abbas, P.I., Peterson, M., Stephens, L.J., Rodrigues, J.R., Lee, T.C., Brandt, M.L. and Lopez, M.E. (2016) Evaluating the Effect of Time Process Measures on Appendectomy Clinical Outcomes. Journal of Pediatric Surgery, 51, 810-814.
https://doi.org/10.1016/j.jpedsurg.2016.02.027
[13]
Eldar, S., Nash, E., Sabo, E., Matter, I., Kunin, J., Mogilner, J.G. and Abrahamson, J. (1997) Delay of Surgery in Acute Appendicitis. The American Journal of Surgery, 173, 194-198. https://doi.org/10.1016/S0002-9610(96)00011-6
[14]
Shin, C., Roh, Y. and Kim, J. (2014) Delayed Appendectomy versus Early Appendectomy in the Treatment of Acute Appendicitis: A Retrospective Study. World Journal of Emergency Surgery, 9, 8-13.
https://doi.org/10.1186/1749-7922-9-8
[15]
Bonadio, W., Rebillot, K., Ukwuoma, O., Saracino, C. and Iskhakov, A. (2017) Management of Pediatric Perforated Appendicitis. The Pediatric Infectious Disease Journal, 36, 937-941. https://doi.org/10.1097/INF.0000000000001025
[16]
Beres, A., Al-Abbad, S. and Puliglanda, P.S. (2010) Appendicitis in Northern Aboriginal Children: Does Delay in Definitive Treatment Affect Outcome? Journal of Pediatric Surgery, 45, 890-893. https://doi.org/10.1016/j.jpedsurg.2010.02.008
[17]
Li, J., Xu, R., Hu, D.M., Zhang, Y., Gong, T.P. and Wu, X.L. (2019) Effect of Delay to Operation on Outcomes in Patients with Acute Appendicitis: A Systematic Review and Meta-Analysis. Journal of Gastrointestinal Surgery, 23, 210-223.
https://doi.org/10.1007/s11605-018-3866-y
