Hospital tests and patient related factors influencing time-to-theatre in 1000 cases of suspected appendicitis: a cohort study

World Journal of Emergency Surgery

Ray McLaughlin¹  Donal Peter O’Leary¹  Suzanne Beecher¹ 

[1] Department of Surgery, Galway University Hospital/National University of Ireland (NUI), Galway, Republic of Ireland

关键词: Complications;    Readmission;    Outcome;    Appendectomy;    Appendicectomy;    Factors;    Time;    Delay;    Appendicitis;   

Others  :  1140131
DOI  :  10.1186/1749-7922-10-6

 received in 2014-12-11, accepted in 2015-01-18,  发布年份 2015

【 摘 要 】

Background

Acute appendicitis is increasingly being managed in the setting of a dedicated emergency theatre. However understanding of hospital factors that influence time-to-theatre (TTT) is poor. Thus, the aim of this study is to identify factors that influence TTT and to observe the effect of prolonged TTT on patient outcome.

Methods

A retrospective review of an electronic prospectively maintained database was performed over a 2 year period. Factors thought to influence TTT were highlighted. A delay was defined as TTT >8 hours. Data analysis was performed using SPSS 20.

Results

1,000 cases of suspected acute appendicitis were identified. Median age was 19 years. Appendicectomy was performed in 90.7%. 68.1% underwent laparoscopic appendicectomy. Overall mean TTT was 12 hours, 27 minutes. There was a significant association between delayed TTT and female gender (p = 0.017), older age (p = 0.001), pre-operative radiology (<0.001), normal WCC (p < 0.001), normal neutrophils (p < 0.001) and histological non-perforated appendix (p < 0.001). However, on multivariate analysis, younger age, a neutrophilia and presence of a perforation had a shorter TTT. Delayed TTT did not affect outcome variables including post-operative collection (3.59% v 4.38%, p = 0.528), readmission rate (6.54% v 5.72%, p = 0.403) and length of stay (3.1 days v 3.34 days, p = 0.823).

Conclusions

This study highlights key hospital factors that influence TTT in patients with suspected appendicitis. Identification of these influential factors adds greatly to our understanding of patient prioritisation. Finally, TTT delays greater than 8 hour do not appear to affect short-term patient outcomes.

【 授权许可】

   
2015 Beecher et al.; licensee BioMed Central.

【 参考文献 】

• [1]Owings MF, Kozak LJ: Ambulatory and inpatient procedures in the United States 1996. Vital Health Stat 1998, 13:1-119.
• [2]Model of care for acute surgery: RCSI. 2013. https://www.rcsi.ie/files/surgery/20131216021838_Model%20of%20Care%20for%20Acute%20Surger.pdf webcite
• [3]Uranues S, Lamont E: Acute care surgery: the European model. World J Surg 2008, 32:1605-12. New South Wales
• [4]Diaz JJ Jr, Norris PR, Gunter OL, Collier BR, Riordan WP, Morris JA Jr: Does regionalization of acute care surgery decrease mortality? J Trauma 2011, 71:442-6.
• [5]Hsee L, Devaud M, Civil I: Key performance indicators in acute surgical unit: have we made an impact? World J Surg 2012, 36:2335-40.
• [6]United Kingdom National Surgical Research Collaborative: Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis. Ann Surg 2014, 259(5):894-903.
• [7]Leff DR, Aggarwal R, Rana M, Nakhjavani B, Purkayastha S, Khullar V, et al.: Laparoscopic skills suffer on the first shift of sequential night shifts: program directors beware and residents prepare. Ann Surg 2008, 247:530-9.
• [8]Teixeira PG, Sivrikoz E, Inaba K, Talving P, Lam L, Demetriades D: Appendectomy timing waiting until the next morning increases the risk of surgical site infections. Ann Surg 2012, 256(3):538-43.
• [9]Dennett E, Omundsen M: Dealy to appendicectomy and associated morbidity: a retrospective review. ANZ J Surg 2006, 76:153-5.
• [10]Ditillo MF, Dziura JD, Rabinovici R: Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg 2006, 244(5):656-60.
• [11]Ingraham AM, Cohen ME, Bilimoria KY: Effect of delay to operation on outcomes in adults with acute appendicitis. Arch Surg 2010, 145:886-92.
• [12]Leppäniemi A, Jousela I: A traffic-light coding system to organize emergency surgery across surgical disciplines. Br J Surg 2014, 101(1):e134-40. doi:10.1002/bjs.9325
• [13]Kim L, Tan ST: Economic impact of untimely surgical intervention for acute plastic surgery patients. NZMJ 2008, 121(1275):26-32.