Short delay in appendix removal safe for some

NEW YORK, May 17 (Reuters) In certain people with acute appendicitis, surgery can be delayed for up to 24 hours after they get to the emergency department, with no increase in the rate of perforations, operating time, or length of hospital stay, investigators report.

For surgeries performed at night, sleep deprivation can have a negative effect on the surgeon's skills, Dr Fadi Abou-Nukta and colleagues point out. On the other hand, improvements in antibiotics have made surgical delay safer. - To evaluate the effect of delayed surgery, the researchers reviewed the records of 309 patients who underwent appendectomy at the Hospital of Saint Raphael in New Haven, Connecticut, between 2002 and 2004. A total of 233 subjects underwent surgery within 12 hours, and 76 between 12 and 24 hours. All patients had been started on IV hydration and antibiotics.

Reasons for postponement included delay in obtaining surgical consultation, lack of operating room availability, and the surgeon's decision to delay the surgical procedure, according to the investigators' report in the Archives of Surgery.

Delay did not appear to significantly affect outcomes, including the number of cases progressing to advanced appendicitis (32 per cent in the early group and 37 per cent in the late group), or other complications, including abscess and wound infection.

Abou-Nukta's team points out that delaying surgery for up to 24 hours decreases the need for late night surgery or interruption of the regular operating room schedule.

In a discussion that took place when the findings were originally presented at the annual meeting of the New England Surgical Society in 2005, Dr Sheridan Oldham in Waterville, Maine pointed out that earlier surgery could ''prevent pain and suffering'' in the people with appendicitis.

In response, Dr Abou-Nukta said they do not recommend delaying surgery if ''someone is having severe pain or is in generalized peritonitis or the patient is very ill to delay until the morning.'' Instead, he explained, surgical delay seems to be safe for ''someone who is having right lower-quadrant pain and mildly elevated white count, having some tenderness in the right lower quadrant, with findings of early appendicitis on CT.'' Reuters SRS RS0940