Behind The Knife: The Surgery Podcast Journal Review in Emergency General Surgery: Appendicitis
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Apr 15, 2024 Can appendicitis wait until morning? Experts debate the pros and cons of delaying appendectomy, highlighting a randomized trial that favors postponed surgeries for stable patients. They discuss crucial metrics like complication rates and trial limitations. The conversation also dives into the Nordic PERFECT trial, which explored timing without increasing perforation risks. Real-world clinical scenarios are used to navigate when immediate surgery is necessary, including unique cases like appendicitis in pregnancy and elderly patients. Discover practical insights that could reshape surgical decisions!
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Delaying Nighttime Appendectomies Is Safe
- Two recent RCTs support delaying non-septic adult appendectomies from overnight to daytime without higher complication rates.
- Delayed surgery may reduce surgeon fatigue and preserve hospital nighttime resources while remaining safe for selected patients.
Delay When Daytime OR Is Available
- For stable, non-septic adult patients with imaging-confirmed appendicitis, consider delaying appendectomy until morning when daytime OR access exists.
- Ensure patients are stabilized, given antibiotics if appropriate, and monitored until definitive surgery.
Why Both ITT And Per-Protocol Matter
- Intention-to-treat and per-protocol analyses are both important in non-inferiority trials because crossovers can bias results.
- The delay trial showed non-inferiority (and per-protocol superiority) despite being slightly underpowered.
