Surgery>>>>>The Appendix
Question 3#

 A 25-year-old man presents with migratory right lower quadrant (RLQ) pain, leukocytosis, and a CT scan consistent with acute, uncomplicated appendicitis. He is physiologically normal and it is 2 AM. You are planning an appendectomy, what difference might be expected in his outcome if his operation is delayed until the next morning?

A) Increased risk of an intra -abdominal abscess
B) Increased risk of surgical-site infection
C) Decreased operative time
D) Increased risk of perforation
E) No difference in perforation rates, surgical-site infection, abscess, conversion rate or operative time

Correct Answer is E

Comment:

There have been three retrospective studies comparing urgent versus emergent appendectomy. No difference was found in the incidence of complicated appendicitis, surgical-site infections, abscess formation, or conversion to an open procedure. While hospital length of stay was longer in the urgent group (as might be anticipated given the delay in definitive surgical care) this was not statistically or clinically different from the emergent group. It may be safe in physiologically normal patients with uncomplicated appendicitis to wait 12 to 24 hours and book them as an "urgent" case.