To evaluate the practice of appendectomy on patients admitted through the emergency department in a 38-bed hospital over a two-year period.
The progression of acute appendicitis has been well documented as a time phenomenon and provides a means for rational analysis. The general assumption is that delay in the diagnosis and surgical management is associated with a more advanced stage of disease (namely appendiceal perforation), an increased incidence of post-operative complications, and a prolonged hospital stay. Many institutions advocate sacrificing diagnositic accuracy for early appendectomy in an attempt to avoid the potential morbidity and morality associated with perforated appendices. However, it is common practice to re-evaluate patients at a later time period of appropriate interval, or admit them for observation, and delay their surgery until the diagnosis is more definite in order to avoid unnecessary operations.
Retrospective review was done on 72 non-incidental appendectomy cases. Emergency department triage time, duration of symptoms, surgery start time, days to regular diet, length of hospitalization, and presence of post-operative complications were recorded. Appendix classification was based on the pathology report and was correlated with operative findings. The effect of outpatient and inpatient delay on appendiceal perforation and post-operative outcome was examined.
There were 53 cases (73.6%) of acute appendicitis, 10 cases (13.9%) of perforated appendicitis, and 7 cases (9.7%) of normal appendectomy. Although we observed a slightly increased average outpatient and inpatient delay among patients with perforated appendices or post-operative complications, statistical analysis revealed this to be not significant (independent groups t test, P>.005). Additionally, there was a statistically significant prolonged days to regular diet and length of hospitalization among patients with perforated appendices or post-operative complications (independent groups t test, P
The quality of care provided to appendectomy patients at this 38-bed hospital, over the two-year study period, was comparable to that reported by other large, retrospective quality assessment studies. The diagnosis of acute appendicitis continues to remain a clinical one. The findings of this study are consistent with that of others, which refute the belief that indiscriminate appendectomy is justified to significantly decease the perforation rate. Surgical delay in the diagnosis and treatment of questionable cases of acute appendicitis do not significantly affect the stage of the disease.
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