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Cited by 370Appendicitis Diagnosis and ManagementStreptococcal Infections and TreatmentsIntraperitoneal and Appendiceal Malignancies

How time affects the risk of rupture in appendicitis

Bickell, Nina A., Aufses, Arthur H., Rojas, Mary, Bodian, Carol·2006·Journal of the American College of Surgeons
DOI 10.1016/j.jamcollsurg.2005.11.016
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Abstract

BACKGROUND: Increasing time between symptom onset and treatment may be a risk factor for a ruptured appendix, but little is known about how the risk changes with passing time. This study aimed to determine the changes in risk of rupture in patients with appendicitis with increasing time from symptom onset to treatment to help guide the swiftness of surgical intervention. STUDY DESIGN: We conducted a retrospective chart review of physician office, clinic, emergency room, and inpatient records of a random sample of 219 of 731 appendicitis patients operated on between 1996 and 1998 at 2 inner-city tertiary referral and municipal hospitals. Conditional risks of rupture were calculated using life table methods. Logistic regression was used to assess factors associated with rupture, and linear regression was used to assess factors affecting time from first examination to treatment. RESULTS: Rupture risk was < or = 2% in patients with less than 36 hours of untreated symptoms. For patients with untreated symptoms beyond 36 hours, the risk of rupture rose to and remained steady at 5% for each ensuing 12-hour period. Rupture was greater in patients with 36 hours or more of untreated symptoms (estimated relative risk [RR]=6.6; 95% CI: 1.9 to 8.3), age 65 years and older (RR=4.2; 95% CI: 1.9 to 6.1), fever > 38.9 degrees C (RR=3.6; 95% CI: 1.2 to 5.7), and tachycardia (heart rate > or = 100 beats/minute; RR=3.4; 95% CI: 1.8 to 5.4). Time between first physician examination and treatment was shorter among patients presenting to the emergency department (median, 7.1 hours versus 10.9 hours; p<0.0001), and those for whom a physician's leading diagnostic impression was appendicitis (6.3 hours versus 11.3 hours; p<0.0001). Patients sent for CT scan experienced longer times to operation (18.6 hours versus 7.1 hours; p<0.0001). CONCLUSIONS: Risk of rupture in ensuing 12-hour periods rises to 5% after 36 hours of untreated symptoms. Physicians should be cautious about delaying surgery beyond 36 hours from symptom onset in patients with appendicitis.

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  • Endometriosis is a significant contributor to false-positive appendectomy diagnoses, particularly in reproductive-aged women; up to 13-22% of negative appendectomy cases in women are later attributed to underlying gynecologic conditions, most commonly endometriosis.

    “Endometriosis is a significant contributor to false-positive appendectomy diagnoses, particularly in reproductive-aged women. Studies have shown that up to 13–22% of negative appendectomy cases in women are later attributed to underlying gynecologic conditions, most commonly endometriosis [35,36].”

    From Selective Appendectomy in Patients Undergoing Minimally Invasive Surgery for Endometriosis: A Retrospective Cohort Study (2025) · cites this paper as [36]

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Authors
Bickell, N. A., Aufses, A. H., Rojas, M., & Bodian, C.
Affiliations
Icahn School of Medicine at Mount Sinai (US)
ORCID
Venue
Journal of the American College of Surgeons
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-03
Volume
202
Issue
3
Pages
401-406
ISSN
1072-7515 (ISSN-L)
DOI
10.1016/j.jamcollsurg.2005.11.016
OpenAlex
W2039484036
Cited by
370
References
21
Citations by year
2026: 20 · 2025: 9 · 2024: 12 · 2023: 15 · 2022: 26 · 2021: 23 · 2020: 30 · 2019: 24 · 2018: 25 · 2017: 22 · 2016: 19 · 2015: 21 · 2014: 15 · 2013: 19 · 2012: 16
FWCI
19.11
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American College of Surgeons (publishedVersion)
  • PubMed (publishedVersion)
Funders
Agency for Healthcare Research and Quality (R-01 HS09698)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
  • Health Sciences › Medicine › Surgery › Intraperitoneal and Appendiceal Malignancies
Keywords
appendicitis, appendiceal perforation, time to treatment, delayed surgery, rupture risk, emergency department presentation, computed tomography, fever, tachycardia, elderly patients, timing of surgery, life table analysis, inner-city hospital, inner-city patients, racial disparities in health care, socioeconomic status, insurance status, hospitalization
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Appendicitis, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Intestinal Perforation, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Rupture, Spontaneous, Time Factors, Incidence, Disease Progression

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