Purpose: Debate on the effect of in-hospital delay on the risk of perforation in appendicitis persists, and the results from previous studies are controversial. The aims of this study were to present the effect of in-hospital delay on the risk of perforation in appendicitis and to assess the utility of C-reactive protein (CRP) measurement in detecting the patients with complicated appendicitis. Methods: Prospectively collected data of 389 adult patients who underwent surgery for acute appendicitis were analyzed in order to find the most accurate method for recognizing the pre-hospital perforations. The effect of in-hospital delay on the further risk of perforation in patients with not yet perforated acute appendicitis was then analyzed. Results: Out of 389 patients with appendicitis, 91 patients (23.4 %) had complicated appendicitis, 23 with abscess, and 68 with free perforation. Admission CRP level of 99 mg/l or higher was 90.3 % specific for complicated appendicitis. In patients with admission CRP less than 99 mg/l, the incidence of perforation doubled from 9.5 to 18.9 % when the in-hospital delay increased from less than 6 h to more than 12 h. Conclusions: Complicated appendicitis can be identified with a high CRP level on admission. Delaying surgery can increase the risk of perforation.
CITATION STYLE
Sammalkorpi, H. E., Leppäniemi, A., & Mentula, P. (2015). High admission C-reactive protein level and longer in-hospital delay to surgery are associated with increased risk of complicated appendicitis. Langenbeck’s Archives of Surgery, 400(2), 221–228. https://doi.org/10.1007/s00423-014-1271-x
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