Does Delaying Appendectomy Cause Complications?

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If a pediatric surgeon needs to delay appendectomy, you can reassure families this is a safe practice and will not increase the risk for adverse outcomes like perforation.

Why does this matter?
Sometimes due to surgical case volume or presentation in the middle of the night, a pediatric surgeon will wait and do the appendectomy as an urgent but non-emergent case.  Is this safe?  This study suggests it is.

Me: "When are you going to take that appendix out, Napoleon?"
Surgeon: "Whenever I want, gosh!!"

This was a retrospective review of a large pediatric appendicitis registry, with 2429 patients.  The rate of complicated appendicitis was 23.6%.  They looked at multiple variables to see if any were associated with an increased risk of complicated appendicitis.  Surprisingly, time to appendectomy was not at all associated with development of complicated appendicitis (OR 0.99 per 1 hour increase in TTA) and this was the same in 22 of the 23 hospitals included in this database.

Source
Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children.  JAMA Pediatr. 2017 Aug 1;171(8):740-746. doi: 10.1001/jamapediatrics.2017.0885.

Peer reviewed by Thomas Davis, MD.

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