High admission C-reactive protein level and longer in-hospital delay to surgery are associated with increased risk of complicated appendicitis.

Abstract

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.

• Authors: Henna E Sammalkorpi, Ari Leppäniemi, Panu Mentula
• Journal: Langenbeck's archives of surgery (Langenbecks Arch Surg) Vol. 400 Issue 2 Pg. 221-8 (Feb 2015) ISSN: 1435-2451 [Electronic] Germany
• PMID: 25586094 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Biomarkers
• C-Reactive Protein

Topics

• Abdomen, Acute (diagnosis, etiology)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Appendectomy (adverse effects, methods)
• Appendicitis (blood, diagnosis, surgery)
• Biomarkers (blood)
• C-Reactive Protein (analysis)
• Delayed Diagnosis
• Female
• Follow-Up Studies
• Humans
• Length of Stay
• Male
• Middle Aged
• Patient Admission
• Postoperative Complications (epidemiology, physiopathology)
• Risk Assessment
• Time-to-Treatment
• Treatment Outcome
• Young Adult