Appendicitis: Why so complicated? Analysis of 5755 consecutive appendectomies

Virginia A. Pittman-Waller, John G Myers, Ronald M Stewart, Daniel L Dent, Carey P. Page, Gina A. Gray, Basil A Pruitt, Harlan D Root

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Abstract

A perceived high rate of complicated (gangrenous or perforated) appendicitis, despite advances in laboratory and radiographic diagnostic modalities, prompted a review of our experience with appendicitis followed by a prospective analysis that examined the time course from presentation to definitive treatment in 218 consecutive patients. In 5755 appendectomies, our overall rate of complicated appendicitis was 32 per cent; higher in males, in the young, and in the elderly; and relatively stable over each year reviewed. Prospectively, we determined that of the various time intervals, the time from the onset of symptoms to first seeking medical attention is the only significant predictor of complicated appendicitis (39.8 vs 16.5 hours for acute appendicitis). On the other hand, the time from surgical evaluation to operative intervention was significantly shorter for complicated appendicitis (3.8 vs 4.7 hours for acute appendicitis). The high rate of complicated appendicitis with its subsequent sequelae of increased morbidity and resource expenditure is primarily the direct result of patient delay in seeking medical attention and not the result of diagnostic dilemma or surgical delay. Public education, specifically targeting those groups at risk, may provide a substantial and significant solution to the complicated appendix.

Original languageEnglish (US)
Pages (from-to)548-554
Number of pages7
JournalAmerican Surgeon
Volume66
Issue number6
StatePublished - Jun 2000

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Appendectomy
Appendicitis
Health Expenditures
Morbidity
Education

ASJC Scopus subject areas

  • Surgery

Cite this

Pittman-Waller, V. A., Myers, J. G., Stewart, R. M., Dent, D. L., Page, C. P., Gray, G. A., ... Root, H. D. (2000). Appendicitis: Why so complicated? Analysis of 5755 consecutive appendectomies. American Surgeon, 66(6), 548-554.

Appendicitis : Why so complicated? Analysis of 5755 consecutive appendectomies. / Pittman-Waller, Virginia A.; Myers, John G; Stewart, Ronald M; Dent, Daniel L; Page, Carey P.; Gray, Gina A.; Pruitt, Basil A; Root, Harlan D.

In: American Surgeon, Vol. 66, No. 6, 06.2000, p. 548-554.

Research output: Contribution to journalArticle

Pittman-Waller, VA, Myers, JG, Stewart, RM, Dent, DL, Page, CP, Gray, GA, Pruitt, BA & Root, HD 2000, 'Appendicitis: Why so complicated? Analysis of 5755 consecutive appendectomies', American Surgeon, vol. 66, no. 6, pp. 548-554.
Pittman-Waller VA, Myers JG, Stewart RM, Dent DL, Page CP, Gray GA et al. Appendicitis: Why so complicated? Analysis of 5755 consecutive appendectomies. American Surgeon. 2000 Jun;66(6):548-554.
Pittman-Waller, Virginia A. ; Myers, John G ; Stewart, Ronald M ; Dent, Daniel L ; Page, Carey P. ; Gray, Gina A. ; Pruitt, Basil A ; Root, Harlan D. / Appendicitis : Why so complicated? Analysis of 5755 consecutive appendectomies. In: American Surgeon. 2000 ; Vol. 66, No. 6. pp. 548-554.
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