Perforation Risk and In-Hospital Delays

Ck Chang, title, K Cho, title, P Fuchshuber, title, B Eklund. Walnut Creek Kaiser


Introduction: Risk for perforated appendicitis is related to the duration of inflammation, of which patient related delays are difficult to quantify, however in-hospital interval are more measurable.

Methods: A total of 4898 appendectomy were performed in adult patient from January 2008 to December 2010 at 21 Kaiser Permanente medical centers in Northern California. Groups were defined based on time to the operating room after admission (≤ 12hrs, ≤ 9hrs and ≤6 hrs) and rate of perforation rate.

Results: Overall perforation rate was 16%, with 81% of the appendectomies performed laparoscopic. Mean age was 40 years old with mean length of stay of 1.7 days. Patient over the age of 65 constituted 9% of the total patients studied. Patient over the age of 65 years old, admission to operating room time > 9hrs and open appendectomies were associated with a higher perforation rate (p<.05). Admission during regular business hours versus after hours were not associated with an increased perforation rate (p=.16). Mean length of stay was longer in patients with perforations and age greater than 65 years old (3.4 and 2.8 days, respectively).

Conclusion: Perforated appendicitis is associated with a higher morbidity and clinical outcome. Admission to operating room time of greater than 9hrs has a negative outcome clinically and on hospital length of stay. Patients greater than age 65 were at higher risk for perforation. Delaying surgery more than 9 hours should be avoided especially in patients greater than 65 years old.

Session Number: Poster – Poster Presentations
Program Number: P048
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