Effect of Delay to Operation on Outcomes in Patients with Acute Appendicitis: a Systematic Review and Meta-analysis.
Acute appendicitis
Appendectomy
Delay
Surgical site infection
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
15
05
2018
accepted:
25
06
2018
pubmed:
8
7
2018
medline:
15
2
2020
entrez:
8
7
2018
Statut:
ppublish
Résumé
Many studies have investigated the association between time interval and incidence of complicated appendicitis and post-operative surgical site infection (SSI), but the results are controversial. A systematic search of the electronic databases identified studies that investigated the association of appendectomy delay with complicated appendicitis and SSI among patients with acute appendicitis. Qualitative and quantitative meta-analysis of the results was conducted. Twenty-one studies were included in the final analysis. Meta-analysis showed no significant difference in complicated appendicitis incidence between patients in the 6-12 h, > 12 and < 6 h groups (OR 1.07, 95% CI 0.89-1.30, p = 0.47; OR 1.04, 95% CI 0.88-1.22, p = 0.64). Comparison of the 6-12 h category with the < 6 h category of in-hospital delay revealed significant associations between longer in-hospital delay and increased risk of post-operative SSI (OR 1.40, 95% CI 1.11-1.77, p = 0.004). Patients in the 24-48 h category had 1.99- and 1.84-fold (p < 0.05) higher odds of developing complicated appendicitis compared to patients in the < 24 h category for pre-hospital delay and total delay, respectively (OR 1.99, 95% CI 1.35-2.94, p = 0.0006; OR 1.84, 95% CI 1.05-3.21, p = 0.03). When pre-hospital and total delay time extended to more than 48 h, the odds of risk increased 4.62- and 7.57-fold, respectively (OR 4.62, 95% CI 2.99-7.13, p < 0.00001; OR 7.57, 95% CI 6.14-9.35, p = < 0.00001). Complicated appendicitis incidence was associated with overall elapsed time from symptom onset to admission or operation; short appendectomy in-hospital delay did not increase the risk of complicated appendicitis but was associated with a slightly increased risk of SSI. Prompt surgical intervention is warranted to avoid additional morbidity, enabling quicker recovery in this population.
Sections du résumé
BACKGROUND
Many studies have investigated the association between time interval and incidence of complicated appendicitis and post-operative surgical site infection (SSI), but the results are controversial.
METHODS
A systematic search of the electronic databases identified studies that investigated the association of appendectomy delay with complicated appendicitis and SSI among patients with acute appendicitis. Qualitative and quantitative meta-analysis of the results was conducted.
RESULTS
Twenty-one studies were included in the final analysis. Meta-analysis showed no significant difference in complicated appendicitis incidence between patients in the 6-12 h, > 12 and < 6 h groups (OR 1.07, 95% CI 0.89-1.30, p = 0.47; OR 1.04, 95% CI 0.88-1.22, p = 0.64). Comparison of the 6-12 h category with the < 6 h category of in-hospital delay revealed significant associations between longer in-hospital delay and increased risk of post-operative SSI (OR 1.40, 95% CI 1.11-1.77, p = 0.004). Patients in the 24-48 h category had 1.99- and 1.84-fold (p < 0.05) higher odds of developing complicated appendicitis compared to patients in the < 24 h category for pre-hospital delay and total delay, respectively (OR 1.99, 95% CI 1.35-2.94, p = 0.0006; OR 1.84, 95% CI 1.05-3.21, p = 0.03). When pre-hospital and total delay time extended to more than 48 h, the odds of risk increased 4.62- and 7.57-fold, respectively (OR 4.62, 95% CI 2.99-7.13, p < 0.00001; OR 7.57, 95% CI 6.14-9.35, p = < 0.00001).
CONCLUSION
Complicated appendicitis incidence was associated with overall elapsed time from symptom onset to admission or operation; short appendectomy in-hospital delay did not increase the risk of complicated appendicitis but was associated with a slightly increased risk of SSI. Prompt surgical intervention is warranted to avoid additional morbidity, enabling quicker recovery in this population.
Identifiants
pubmed: 29980978
doi: 10.1007/s11605-018-3866-y
pii: 10.1007/s11605-018-3866-y
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
210-223Références
Ann Surg. 1905 Mar;41(3):437-50
pubmed: 17861613
Ann Surg. 2012 Sep;256(3):538-43
pubmed: 22842128
Am J Surg. 1997 Mar;173(3):194-8
pubmed: 9124625
BMJ. 1994 Jan 8;308(6921):107-10
pubmed: 8298378
World J Surg. 2007 Jan;31(1):86-92
pubmed: 17180556
Lancet. 2015 Sep 26;386(10000):1278-1287
pubmed: 26460662
J Am Coll Surg. 2006 Mar;202(3):401-6
pubmed: 16500243
Am Surg. 2007 Jun;73(6):626-9; discussion 629-30
pubmed: 17658102
World J Surg. 2011 Jul;35(7):1626-33
pubmed: 21562871
Pediatr Emerg Care. 2015 Nov;31(11):753-8
pubmed: 26535497
J Pediatr Surg. 2014 Jun;49(6):1026-9; discussion 1029
pubmed: 24888856
Ann Surg. 1995 Mar;221(3):278-81
pubmed: 7717781
J Gastrointest Surg. 2011 Jul;15(7):1223-31
pubmed: 21557019
Pediatrics. 2017 Jun;139(6):
pubmed: 28562252
Ann Surg. 2001 Apr;233(4):455-60
pubmed: 11303128
Stat Med. 2001 Feb 28;20(4):641-54
pubmed: 11223905
Dig Surg. 2008;25(5):394-9
pubmed: 19065056
Arch Surg. 2006 May;141(5):504-6; discussioin 506-7
pubmed: 16702523
Pathol Res Pract. 2000;196(2):89-93
pubmed: 10707364
Ann Surg. 2014 Jul;260(1):109-17
pubmed: 24646528
Eur J Cancer. 2015 Dec;51(18):2747-58
pubmed: 26597445
Langenbecks Arch Surg. 2015 Feb;400(2):221-8
pubmed: 25586094
Dig Surg. 2017;34(1):25-29
pubmed: 27380624
J Ayub Med Coll Abbottabad. 2005 Apr-Jun;17(2):37-9
pubmed: 16092648
World J Emerg Surg. 2016 Jul 18;11:34
pubmed: 27437029
Ann Coloproctol. 2018 Feb;34(1):11-15
pubmed: 29535982
Dis Colon Rectum. 2008 Dec;51(12):1823-7
pubmed: 18584252
World J Surg. 2012 Dec;36(12):2787-94
pubmed: 22948195
Med J Aust. 2010 Sep 6;193(5):281-4
pubmed: 20819047
ANZ J Surg. 2004 Sep;74(9):773-6
pubmed: 15379809
Am Surg. 2016 Jan;82(1):65-74
pubmed: 26802860
Ann Surg. 2006 Nov;244(5):656-60
pubmed: 17060754
Arch Surg. 2010 Sep;145(9):886-92
pubmed: 20855760
World J Surg. 2016 Jun;40(6):1315-7
pubmed: 26935563
Am J Surg. 2003 Aug;186(2):169-74
pubmed: 12885613
Surg Endosc. 2006 May;20(5):717-20
pubmed: 16544077
JAMA. 2000 Apr 19;283(15):2008-12
pubmed: 10789670
J Surg Res. 2016 May 1;202(1):126-31
pubmed: 27083958
N Engl J Med. 2015 May 14;372(20):1937-43
pubmed: 25970051
J Pediatr Surg. 2004 Mar;39(3):464-9; discussion 464-9
pubmed: 15017571
World J Surg. 2014 Jun;38(6):1381-7
pubmed: 24430507
Curr Probl Surg. 2005 Oct;42(10):688-742
pubmed: 16198668
Ann Surg. 2014 May;259(5):894-903
pubmed: 24509193
World J Surg. 2016 Jun;40(6):1308-14
pubmed: 26810991
N Am J Med Sci. 2013 Jan;5(1):22-7
pubmed: 23378951
Int J Surg. 2010;8(5):336-41
pubmed: 20171303
Am J Surg. 2010 Dec;200(6):810-3; discussion 813
pubmed: 21146025
JAMA. 2015 Jun 16;313(23):2340-8
pubmed: 26080338