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 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more recent episodes: https://app.behindtheknife.org/listen