Factors affecting perforation in acute appendicitis

T. D. Koepsell, T. S. Inui, V. T. Farewell

Research output: Contribution to journalArticle

40 Scopus citations


Early diagnosis and prompt surgical treatment have long been advocated for acute appendicitis to prevent the consequences of perforation. The frequency of perforation in a series of patients with appendicitis has been used as an index of the promptness of surgical care in comparing the care given among hospitals or over time. Data presented illustrate that perforation of the appendix is strongly influenced by patient factors, over which surgeons often have little control. First, variation of a few hours in the timing of surgical care once patients have been admitted appears to be a much less important contributor to perforation than variations in the length of the prehospitalization phase of illness. Second, the risk of perforation depends not only upon the duration of the symptoms of the patient but also upon other patient characteristics, particularly age. Third, the increased perforation rates among patients at the extremes of age appear to be due not just to differences in the timing of surgical treatment but to real differences in the natural history of the disease. These observations suggest that perforation rates should have, at most, a rather limited role as indicators of the quality or timeliness of surgical care. The findings also permit speculation that a single clinical strategy may not necessarily be optimal for all patients with appendicitis.

Original languageEnglish (US)
Pages (from-to)508-510
Number of pages3
JournalSurgery Gynecology and Obstetrics
Issue number4
StatePublished - Jan 1 1981
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology

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