대한대장항문학회

Purpose : During the night time decision making on patients suspicious of appendicitis is<br>often difficult because diagnosis and timing for operation are frequently delayed. Therefore,<br>we analyzed above cases and solution is suggested. Methods : This retrospective study<br>included 360 patients who underwent laparotomies for suspected appendicitis at Hanil Hospital<br>during one year, from March 1998 to Feb. 1999. They were divided into two groups according<br>to presenting time to physician (Day time: 6 a.m. to 6 p.m., Night time: 6 p.m. to 6 a.m.). Sex<br>& age distribution, time of presentation to physician, duration of symptoms, symptoms &<br>physical findings, white blood cell counts, interval from presentation to operation, hospital<br>stay, and pathologic diagnosis were compared. Results : There were no significant differences<br>in sex & age distribution, duration of symptoms, symptoms & physical findings, white blood<br>cell counts, pathologic diagnosis between the two groups. However, during the night time, the<br>interval from presentation to operation was longer than that of the day time (9.15 hours<br>versus 4.83 hours, p＜0.001), the rate of delayed appendectomy during the night was 58.0%,<br>the rate of negative laparotomy increased when appendectomy was delayed for more than 12<br>hours compared with less than 12 hours (28.1% vs 11.7%, p＜0.01), and in the cases with<br>perforated appendicitis, delayed appendectomy for more than 12 hours had longer hospital<br>stay compared with less than 12 hours (12 days vs 9.44 days, p＜0.01). Factors causing<br>delayed appendectomy were related to the physician (42.5%), lack of anesthetic & nursing<br>supports (19.5%), failure to structure the operation team (20.7%), and patient itself (17.3%).<br>When white blood cell counts were rechecked in the next morning, levels above 10,000<br>cells/㎣ were highly associated with appendicitis in contrast to that below 10,000 cells/㎣<br>(91.7% vs 43.5%, p＜0.002) Conclusions : We suggest that (1) during the night time, when<br>diagnosis for appendicitis is uncertain, it must be supported by active clinical review, advices<br>from senior staff, and special diagnostic methods (ultrasonography, etc); (2) rechecked white<br>blood cell counts above 10,000 cells/㎣ in the next morning may contribute to diagnosis<br>and decision for early operation; (3) if operation is decided in the next morning, operation<br>should be done before or between the elective operations, especially in case of suspected<br>perforation, to reduce complications and length of hospital stay.<br>