1. In patients diagnosed with simple appendicitis, surgery within 24 hours was noninferior to surgery within 8 hours with respect to the risk of appendiceal perforation.
2. There were no deaths reported in either group.
Evidence evaluation level: 1 (great)
research summary: Appendectomy or appendectomy is the standard treatment for appendicitis, but there is no consensus regarding the optimal timing of surgery for acute, uncomplicated appendicitis. Some studies suggest that longer in-hospital delays may be as good as shorter delays, but further research is needed. This randomized controlled trial aimed to compare the rate of appendiceal perforation in patients who underwent an unplanned appendectomy within his 8 hours and within her 24 hours. The primary outcome was appendiceal perforation rate, and the important secondary outcome was 30-day complication rate. Study results showed that appendectomy performed within 24 hours did not increase the risk of appendix perforation compared with surgery scheduled within 8 hours. Although this study was well conducted, it was limited to specific centers in Finland and Norway, affecting generalizability to other health systems.
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detail [randomized-controlled trial]: From May 18, 2020 to December 31, 2022, 2,095 patients were tested for eligibility at three hospitals in Finland and Norway. Patients aged 18 years and older with uncomplicated acute appendicitis were included, excluding those with perforation, fever, high C-reactive protein, or signs of complicated appendicitis on imaging. A total of 1,805 patients (907 in the 8-hour group and 896 in the 24-hour group) were included in the final analysis.The primary results of this study showed that scheduling appendectomy within 24 hours was noninferior to scheduling within 8 hours in terms of appendiceal perforation rates (9 in the less than 24 hours group). % vs. 8% in groups less than 8 hours, 95% confidence) interval [CI] -2.1 to 3.2, p=0.68, risk ratio 1.065). Secondary outcomes showed no significant difference in 30-day complication rates between the two groups (6% in the <24 hours group vs. 7% in the <8 hours group, p=0.39). Additionally, total operative time and conversion rate to open surgery were similar between groups. The results of this study suggest that delaying appendectomy by up to 24 hours does not increase the risk of appendiceal perforation in patients with uncomplicated appendicitis and allows for better allocation of operating room resources. .
Image: P.D.
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