Delaying Appendicitis Treatment Could Lead to Death

Delaying treatment for appendicitis beyond two days after children were admitted to a hospital led to more complications, higher health care costs, and even death, according to a new study.

Researchers from St. Elizabeth Medical Center (Boston, MA, USA) identified 683,016 patients from the US National Inpatient Sample (aged 18 or younger), who suffered from appendicitis between 2000 and 2008. In 17,737 of those children (2.6%), surgery was performed on in-hospital day two or later, with a mean interval from hospitalization to appendectomy of 4.5 days. These children had a 22.6% incidence rate of perforated appendicitis, compared to 18.9% in those children receiving more immediate treatment. The delayed treatment group also had a 20-fold increase in mortality, leaping from 0.03% to 0.68%.

The results also showed that delayed treatment was associated with a 13-fold increase in drainage procedures, a six-fold increase in cecectomies, an 11-fold increase in small bowel lacerations, a 15-fold increase in small bowel resections, and a 14-fold increase in hemicolectomies. Additionally, mean hospital stay was more than 10 days for the delayed treatment group versus only 2.89 days for promptly treated children. On multivariate analysis, a delay in treatment was predicted by acute lymphoid leukemia, acute myeloid leukemia, neutropenia, and ovarian cyst without torsion. The study was presented at the annual American Academy of Pediatrics (AAP) national conference and exhibition, held during October 2011 in Boston (MA, USA).

“If surgery is done within 24 hours, there is no relationship between time to procedure and outcome,” said lead author and study presenter Justin Lee, MD. “The 48-hour time period may be a clinically important time period in which uncomplicated appendicitis can become complicated appendicitis with peritonitis, rupture, or periappendiceal abscess.”

Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Appendicitis has been recognized as one of the most common causes of severe acute abdominal pain worldwide; untreated, mortality is high, mainly because of the risk of rupture leading to peritonitis and shock.

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