Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial
- PMID: 37436871
- DOI: 10.1097/SLA.0000000000005996
Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial
Abstract
Objective: To assess whether delaying appendectomy until the following morning is non-inferior to immediate surgery in those with acute appendicitis presenting at night.
Background: Despite a lack of supporting evidence, those with acute appendicitis who present at night frequently have surgery delayed until the after morning.
Methods: The delay trial is a noninferiority randomized controlled trial conducted between 2018 and 22 at 2 tertiary care hospitals in Canada. Adults with imaging confirmed acute appendicitis who presented at night (8:00 pm -4:00 am ). Delaying surgery until after 6:00 am was compared with immediate surgery. The primary outcome was 30-day postoperative complications. An a prior noninferiority margin of 15% was deemed clinically relevant.
Results: One hundred twenty-seven of the planned 140 patients were enrolled in the Delayed Versus Early Laparoscopic Appendectomy (DELAY) trial (59 in the delayed group and 68 in the immediate group). The two groups were similar at baseline. The mean time between the decision to operate and surgery was longer in the delayed group (11.0 vs 4.4 hours, P < 0.0001). The primary outcome occurred in 6/59 (10.2%) of those in the delayed group versus 15/67 (22.4%) of those in the immediate group ( P = 0.07). The difference between groups met the a priori noninferiority criteria of +15% (risk difference -12.2%, 95% CI: -24.4% to +0.4%, test of noninferiority P < 0.0001).
Conclusions: The DELAY study is the first trial to assess delaying appendectomy in those with acute appendicitis. We demonstrate the noninferiority of delaying surgery until the after morning.
Trial registration: ClinicalTrials.gov NCT03524573.
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Conflict of interest statement
The authors report no conflicts of interest.
Similar articles
-
Delayed vs. Early Appendectomy (DELAY) trial for adult patients with acute appendicitis: Study protocol for a randomized controlled trial.Contemp Clin Trials. 2021 Mar;102:106288. doi: 10.1016/j.cct.2021.106288. Epub 2021 Jan 23. Contemp Clin Trials. 2021. PMID: 33497834
-
Enhanced recovery after surgery protocol allows ambulatory laparoscopic appendectomy in uncomplicated acute appendicitis: a prospective, randomized trial.Surg Endosc. 2019 Feb;33(2):429-436. doi: 10.1007/s00464-018-6315-9. Epub 2018 Jul 9. Surg Endosc. 2019. PMID: 29987566 Clinical Trial.
-
Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial.JAMA. 2015 Jun 16;313(23):2340-8. doi: 10.1001/jama.2015.6154. JAMA. 2015. PMID: 26080338 Clinical Trial.
-
Appendectomy versus antibiotic treatment for acute appendicitis.Cochrane Database Syst Rev. 2011 Nov 9;(11):CD008359. doi: 10.1002/14651858.CD008359.pub2. Cochrane Database Syst Rev. 2011. Update in: Cochrane Database Syst Rev. 2020 Oct 1;10:CD008359. doi: 10.1002/14651858.CD008359.pub3. PMID: 22071846 Updated. Review.
-
Is laparoscopic appendectomy the new 'gold standard'?Arch Surg. 1995 Jul;130(7):782-5. doi: 10.1001/archsurg.1995.01430070104022. Arch Surg. 1995. PMID: 7611871 Review.
Cited by
-
Navigating appendicitis care during the Covid-19 pandemic: a retrospective cohort study in China.BMC Surg. 2024 May 28;24(1):166. doi: 10.1186/s12893-024-02466-4. BMC Surg. 2024. PMID: 38807152 Free PMC article.
-
Implementation of artificial intelligence-based computer vision model in laparoscopic appendectomy: validation, reliability, and clinical correlation.Surg Endosc. 2024 Jun;38(6):3310-3319. doi: 10.1007/s00464-024-10847-2. Epub 2024 Apr 25. Surg Endosc. 2024. PMID: 38664295
-
Diagnostic Accuracy of Ileocolic Artery and Vein Diameter for Acute Appendicitis.Med Sci Monit. 2024 Mar 1;30:e943846. doi: 10.12659/MSM.943846. Med Sci Monit. 2024. PMID: 38425035 Free PMC article.
References
-
- Pfuntner A, Wier LM, Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2010. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006.
-
- Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. A prospective study. Ann Surg. 1995;221:278–281.
-
- Boomer LA, Cooper JN, Anandalwar S, et al. Delaying appendectomy does not lead to higher rates of surgical site infections: a multi-institutional analysis of children with appendicitis. Ann Surg. 2016;264:164–168.
-
- Ingraham AM, Cohen ME, Bilimoria KY, et al. Effect of delay to operation on outcomes in adults with acute appendicitis. Arch Surg (Chicago, Ill: 1960). 2010;145:886–892.
-
- Jeon BG, Kim HJ, Jung KH, et al. Appendectomy: should it be performed so quickly? Am Surg. 2016;82:65–74.
Publication types
MeSH terms
Associated data
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous