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Saar S, Talving P, Laos J, Põdramägi T, Sokirjanski M, Lustenberger T, Lam L, Lepner U. Delay Between Onset of Symptoms and Surgery in Acute Appendicitis Increases Perioperative Morbidity: A Prospective Study. World J Surg 2017; 40:1308-14. [PMID: 26810991 DOI: 10.1007/s00268-016-3416-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite significant progress in surgery, controversy persists about timing of appendectomy. Objective of this prospective observational study was to determine associations between time interval from onset of symptoms in appendicitis to appendectomy and postoperative complications. METHODS After institutional review board approval, all adult consecutive patients subjected to emergency appendectomy between 1/9/2013 and 1/12/2014 were prospectively enrolled. Data collection included demographics, open vs. laparoscopic appendectomy, comprehensive complication index (CCI), and 30-day follow-up. To determine time-dependent associations between delay of surgery and complications all patients were stratified into subgroups based on 12-h time intervals from onset of abdominal pain to surgery. Primary outcome was complications per CCI in correlation to delay from symptoms to appendectomy. Secondary outcomes included duration of surgery, hospital length of stay (HLOS), and incidence of complication within 30-day follow-up. RESULTS A total of 266 patients with a mean age of 35.4 ± 14.8 years met inclusion criteria. Overall, 83.1 % of patients were subjected to laparoscopic appendectomy. Delay to surgery in 12-h increments showed stepwise-adjusted increase in complications per CCI (adj. P = 0.037). Also, delay to appendectomy increased significantly duration of surgery and HLOS, respectively (adj. P < 0.001 and adj. P < 0.001). Overall, 5.7 % of patients developed a surgical site infection after hospital discharge. CONCLUSION Extended time interval from the onset of initial symptoms to appendectomy is associated with increased complications per CCI, duration of surgery, and HLOS in acute appendicitis. Prompt appendectomy in acute appendicitis is warranted.
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Affiliation(s)
- Sten Saar
- School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia
| | - Peep Talving
- School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia. .,Department of Surgery, Tartu University Hospital, Puusepa 1a, 50406, Tartu, Estonia. .,Department of Surgery, School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
| | - Juhan Laos
- School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia
| | - Taavi Põdramägi
- School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Department of Surgery, Tartu University Hospital, Puusepa 1a, 50406, Tartu, Estonia
| | - Maksim Sokirjanski
- School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia
| | - Thomas Lustenberger
- Division of Trauma, Hand and Reconstructive Surgery, Goethe University Hospital, Frankfurt/Main, Germany
| | - Lydia Lam
- Division of Acute Care Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA
| | - Urmas Lepner
- School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Department of Surgery, Tartu University Hospital, Puusepa 1a, 50406, Tartu, Estonia.,Department of Surgery, School of Medicine, University of Tartu, Puusepa 8, 51014, Tartu, Estonia
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Saar S, Sokirjanski M, Junkin LK, Laos J, Laar AL, Merioja I, Lepner U, Kukk L, Remmelgas A, Asser T, Innos K, Starkopf J, Talving P. Evolution of severe trauma in Estonia comparing early versus established independence of the state. Eur J Trauma Emerg Surg 2016; 43:791-796. [PMID: 27738725 DOI: 10.1007/s00068-016-0731-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Trauma mechanisms and patterns of severe injuries during the Estonian independence have not been evaluated. The aim of the study was to compare the incidence and outcomes of severe injuries between time periods of early independence from the Soviet Union and the present time. METHODS After the ethics review board approval, all adult trauma admissions to major trauma facilities in 1993-1994 and 2013-2014 with Injury Severity Score >15 were identified. Data collection included demographics, injury severity variables, interventions, and in-hospital outcomes. Primary outcome was in-hospital mortality. Secondary outcomes included incidence of penetrating trauma, hospital length of stay (HLOS), and in-hospital complications. Primary outcome difference comparing the two time segments was determined using logistic regression analysis. RESULTS A total of 1064 patients were included, 593 and 471 from 1993-1994 to 2013-2014, respectively. Incidence of penetrating trauma during 1993-1994 was 11.1 % and in 2013-2014 at 6.4 % (p = 0.007). Gunshot injuries constituted 62.1 and 23.3 % of all penetrating trauma in 1993-1994 and 2013-2014, respectively (p < 0.001). The overall mean HLOS was 15.5 ± 19.8 days and did not differ between the periods. The rate of adjusted complications showed a trend for a decreased incidence (adj. p = 0.064). Adjusted mortality rate was 50.3 and 16.4 % during 1993-1994 and 2013-2014, respectively (adj. OR 7.01; 95 % CI 4.69-10.47; p < 0.001). CONCLUSIONS Effective law enforcement, gun control, evolution of trauma system, and reduction of interpersonal violence have all contributed to a significant decrease in penetrating trauma incidence and all-cause adjusted mortality during the 20 years of Estonian independence.
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Affiliation(s)
- S Saar
- School of Medicine, University of Tartu, Tartu, Estonia.,Department of Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia
| | - M Sokirjanski
- School of Medicine, University of Tartu, Tartu, Estonia
| | - L K Junkin
- School of Medicine, University of Tartu, Tartu, Estonia
| | - J Laos
- School of Medicine, University of Tartu, Tartu, Estonia.,Department of Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia
| | - A L Laar
- School of Medicine, University of Tartu, Tartu, Estonia
| | - I Merioja
- School of Medicine, University of Tartu, Tartu, Estonia
| | - U Lepner
- School of Medicine, University of Tartu, Tartu, Estonia.,Department of Surgery, Tartu University Hospital, Tartu, Estonia
| | - L Kukk
- Department of Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia
| | - A Remmelgas
- Department of Anaesthesiology, North Estonia Medical Center, Tallinn, Estonia
| | - T Asser
- School of Medicine, University of Tartu, Tartu, Estonia.,Department of Neurosurgery, Tartu University Hospital, Tartu, Estonia
| | - K Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - J Starkopf
- School of Medicine, University of Tartu, Tartu, Estonia.,Department of Anaesthesiology and Critical Care, Tartu University Hospital, Tartu, Estonia
| | - P Talving
- School of Medicine, University of Tartu, Tartu, Estonia. .,Department of Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia. .,Department of Surgery, Tartu University Hospital, Tartu, Estonia.
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