Title : The implications of delaying operative management of CT confirmed uncomplicated appendicitis.
Abstract:
Uncomplicated appendicitis (UA) remains a surgically managed condition in Australia and with CT scans becoming more prevalent, the patient’s appendicitis is often categorised at the time of their admission. UA patients are suitable for post operative same day discharge, hence prompt surgical intervention is desirable. Frequently these patients have surgical treatment unintentionally delayed, unless they deteriorate clinically. Despite adjunct antimicrobial therapy, many patients arrive to the operating theatres with a complicated appendicitis, not in keeping with their original imaging. This observation provides the basis for the primary objective - to identify the proportion of patients with uncomplicated appendicitis on CT imaging which present with complicated appendicitis at the time of the operation and the difference in post operative length of stay.
Methodology: Patients who underwent a laparoscopic appendicectomy from April 2018 – April 2023 at the Royal Brisbane and Women’s Hospital were analysed. These patients were retrieved via the ORMIS database via ICD procedural codes. Of 1646 patients, 694 patients had a CT scan prior to an isolated laparoscopic appendicectomy. 593 were diagnosed with uncomplicated appendicitis. Their intraoperative notes were reviewed to determine if perforation was present.
Results: 74 patients who received an uncomplicated diagnosis on CT had intra-operative perforation. The time to procedure in the complicated group was on average 10 hours longer and their median length of post-operative stay was 2.7 days longer.
Conclusions: Results of this study suggest that expediting laparoscopic appendicectomies for CT proven uncomplicated appendicitis would reduce average length of post-operative stay.
Audience Take Away Notes:
- The audience will learn the value of expediting common operations and will be able to use the information in their local departments to push for extra funding for after hours operating theatres. It will also convey the limitations of imaging in the prioritisation of patients for surgery. The aim of the paper is to help the audience appreciate that prompt surgical intervention for appendicitis will not only improve patient morbidity, but it will also improve the use of finite resources in the department. This research is a great building block for expansion of the concept into other surgical procedures for all surgical specialties.
