DELAY OF SURGERY IN ACUTE APPENDICITIS

BACKGROUND AND OBJECTIVES: If is generally assumed that delayed diagno sis of acute appendicitis results in higher morbidity but this assumpt ion is not strongly supported in the literature. We attempt to define the effect of patient and physician delay on the outcome of patients w ith acute appendicitis. PATIENTS AND METHODS: We studied 486 patients admitted between 1980 and 1992. Patient delay in presenting to a physi cian and surgeon delay from hospital admission to operation were studi ed in relation to stage of disease at operation as well as to postoper ative complications. RESULTS: Postoperative complications occurred in 10% of cases with simple acute appendicitis versus about 20% of cases with gangrenous or perforated appendicitis (P<0.001). The mean patient delay from onset of symptoms to presentation to a physician was 1.7 d ays in simple acute appendicitis versus 2.3 days in gangrenous or perf orated appendicitis (P<0.001). Mean surgeon delay was 13.6 hours in si mple acute appendicitis versus 14.5 hours in advanced appendicitis (P = NS). CONCLUSION: Delay in patient presentation adversely affects the stage of disease in acute appendicitis and leads to increased inciden ce of infectious complications and to prolonged hospital stay. Convers ely, physician delay does not affect the stage of disease. A surgeon's decision to observe patients in hospital in order to clarify the diag nosis is justified, as it does not adversely affect outcome. (C) 1997 by Excerpta Medica, Inc.