nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Tuesday, September 21, 2010

Emergency Surgery Not Always Needed For Appendicitis?

The headline in the media is misleading.  It sounds like you can get away with not doing surgery.

There's an article in the USA Today Health & Behavior blog (Sep 20) that implies just that.  Here's the title:  "Some appendicitis cases may not require 'emergency' surgery."  The key word, which they were smart enough to put in quotes, is "emergency."

The research that led to the news article is in the Archives of Surgery (Sep 2010).

The method used to document the outcomes of delaying the surgery can be criticized.  They didn't look at whether the surgeons were "sure" (as far as you can be) that the patient had appendicitis before operating, and didn't account for cases where the diagnosis was uncertain until further observation showed that the appendix was getting more inflamed.  They just abstracted data from the medical record, classifying patients into one of three groups--whether the patient had an appendectomy in less than six hours, 6-12 hours, or more than 12 hours from admission to the hospital.

They found no difference in outcomes among the three groups (but they all had their appendix out...)

For Onion Peelers,
Of 32 782 patients, 24 647 (75.2%) underwent operations within 6 hours of surgical admission, 4934 (15.1%) underwent operations more than 6 through 12 hours, and 3201 (9.8%) underwent operations more than 12 hours after surgical admission.  No significant differences were found in adjusted overall morbidity (5.5%, 5.4%, and 6.1%, respectively; P = .33) or serious morbidity/mortality (3.0%, 3.6%, and 3.0%, respectively; P = .17).

The description of the study above shows you what they mean by "emergency" surgery.  They mean operating as soon as possible after you walk in the door, rather than as soon as poosible after the diagnosis is certain enough to operate.

You can debate whether an operation 24 hours later--when the uncertainty over the diagnosis has been clarified as the patient gets worse and the appendix becomes clearly inflamed--is not really an "emergency."

In my book, it is an emergency.  Because, you're doing "watchful waiting" until a decision can be made, and then proceeding in an emergent fashion.


The bottom line is, appendicitis needs an appendectomy.  Nobody (except me, of course.  see here) should mess around with severe abdomenal pain that suggests appendicitis.  To do so is foolish and lethal.

Yes, there have been extremely rare cases in which patients "appear" to have resolved their appendicits. But it's not clear that they actually had the diagnosis in the first place.

And I'm not betting my life on a miracle.

Doc D

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