Delayed appendectomy in the pediatric patient. How safe is it?

Abstract

Delayed appendectomy is an option in centers where there is no pediatric surgeon on call. Objective: to analyze the results of delayed versus immediate surgery in non-complicated appendicitis in pediatric patients. Patients and Method: Analytical quasi-experimental study including appendectomies performed for uncomplicated appendicitis in children aged between 6 and 14 years. We compared the outcomes of the group of patients operated on at the time of diagnosis with those operated on the following day. Demographic and general variables and postoperative evolution were analyzed. The main variables were the length of stay and postoperative complications. We also analyzed factors related to the finding of gangrenous appendicitis during surgery. Results: Forty-five patients were included in the study, 21 in the immediate-surgery group (AIn) and 24 in the delayed-surgery group (ADif). The ADif group underwent surgery on average 21 hours after diagnosis. There were no significant differences in the mean length of stay and no significant increase in complications were de-tected in the ADif group. In the complementary analysis, the presence of appendicolith increased the probability of gangrenous appendicitis. Conclusions: Delaying appendectomy in selected patients with uncomplicated appendicitis did not significantly increase either hospital stay or complication rate in our series. If we correctly identify these patients, some referrals could be avoided since these entail stress for the family and overload referral centers.