Comparison Between Early Appendicectomy and Delayed Appendicectomy in Treating Acute Appendicitis

Abstract

Background: Acute appendicitis is the most common emergency condition that faces the surgeon worldwide. The overall lifetime risk of having acute appendicitis is estimated to be 6–7 %, with a peak incidence between 10 and 30 years. Early and sometimes immediate appendicectomy is standard, fearing the risk of pathological progression into perforation, gangrenous appendicitis, and abscess formation. However, recently, this practice has been challenged by authors giving a suggestion that appendicectomies can be delayed in some cases and still devoid of adverse postoperative outcomes. Objective: This study aimed at comparing the two groups regarding the following postoperative outcomes: WBC count on a postoperative day one, time last to a soft liquid diet, rate of complication, length of in-hospital stay, and the need for admission within 30 days of doing the surgery. Patients and Methods: This is a prospective randomized study of 341 patients (196 male and 145 female) who underwent appendicectomy over a period of eleven months (May 2019- March 2020) in Baquba Teaching Hospital in Diyala Governorate. The patients categorized into two groups for making the comparison (all underwent appendectomy): group A: 181 patients (male 108, female 73) include those who are operated on within 8 hours of arrival to the hospital and group B: 160 patients (male 81, female 79) include those who are operated on after 8 hours of arrival to the hospital. The patients in the two groups were compared regarding the following postoperative outcomes as WBC count at day one postoperatively, time duration to a liquid diet, rate of complication, length of in-hospital stay, and finally, the need for readmission during the first 30 days of doing the surgery. Results: Regarding the mean white blood cell count at the first postoperative day, it was lower for group B. than that for group A (p-value 0.0018). With regard to the timing of starting having liquid diet, there was no significant difference, and the patients in the two groups started oral liquid diet within the first 24 hours (p-value 0.0715). There was no significant difference between the two groups regarding the immediate and early postoperative complication rate; 0.02% in group A and 0.37% for group B (p-value 0.4022), the length of postoperative hospital stay was the same for the two groups, ranging between 2 days and less than one day (p value 0.0826). There was no significant difference between the two groups regarding the need for readmission within 30 days, 0.016% in group A and 0.025% in group B (p-value 0.9984). Conclusion: This study concluded that delayed appendicectomy was safe and feasible for patients with uncomplicated appendicitis. Despite that the clinical outcomes of delayed appendicectomy were not better than those with early appendicectomy. Also Delayed appendicectomy can improve the quality of care provided by the residents, surgeons, anesthetists and theater staff, enhance patient's quality of care, and it allows an increased efficient utilization of medical resources and theaters for other life-threatening emergency cases.