Behind The Knife: The Surgery Podcast15 Apr 2024

Journal Review in Emergency General Surgery: Appendicitis

Can appendicitis wait until the morning? Join Drs. Ashlie Nadler, Jordan Nantais, Graham Skelhorne-Gross, and Marika Sevigny from our Emergency General Surgery Team as they discuss the role of deferring appendectomies from overnight to the next morning.

Paper 1: Patel SV, Zhang L, Mir ZM, Lemke M, Leeper WR, Allen LJ, Walser E, Vogt K. Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial. Ann Surg. 2024 Jan 1;279(1):88-93.
https://pubmed.ncbi.nlm.nih.gov/37436871/

-Non-inferiority randomized controlled trial comparing delayed appendectomy group with surgery taking place after 0600 the morning following a decision to operate versus the immediate appendectomy group with surgery taking place between 8pm and 4am and within 6 hours of a decision to operate

-A priori non-inferiority margin of 15% for 30-day complications

-Intention-to-treat analysis with risk difference -12% in favor of the delayed group (p < 0.001)

-Superiority as on per protocol analysis

-Underpowered at 91% due to early closure of study due to loss of reliable day time emergency triage operating time

Paper 2: Jalava K, Sallinen V, Lampela H, Malmi H, Steinholt I, Augestad KM, Leppäniemi A, Mentula P. Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomised controlled trial. Lancet. 2023 Oct 28;402(10412):1552-1561.
https://pubmed.ncbi.nlm.nih.gov/37717589/

-Non-inferiority randomized controlled trial comparing appendectomy within 8 hours versus 24 hours

-No difference in rate of perforation on intention-to-treat or per protocol analyses

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