Review of literature and expert opinions Acute care surgery requires punctual evaluation and early intervention, usually for diseases of short duration. The notion that expeditious management of acute Givinostat molecular weight surgical diseases is the appropriate strategy is based on the knowledge that delaying treatment may increase the risks of adverse outcomes. This study was approved by the ethical committee of the selleck kinase inhibitor Rambam Health Care Center. Most non-traumatized surgical patients
present to the emergency department with one of three leading complaints: 1. abdominal or groin pain, 2. gastrointestinal bleeding 3. soft tissue infection. After thorough investigation, most of these clinical patterns evolve into unambiguous diagnoses. Some of the clinical patterns that represent acute surgical disease are managed by emergency surgery. Moreover, in certain situations, only surgery leads to proper diagnosis. Other situations require further nonsurgical
investigation, and may be treated sufficiently by conservative management. Deferring surgery to daytime hours is appropriate in certain situations. On the other hand, inappropriate delaying of surgery may result in further contamination of the abdominal cavity (perforation of duodenal ulcer, perforated diverticulitis) or perforation of an inflamed organ (appendix) if left untreated. Soft tissue infections (perianal abscess, Blasticidin S cell line gluteal abscess) may progress to soft tissue gangrene if treatment is postponed, especially in patients who suffer co- morbidities, such as diabetes mellitus. Delaying treatment in a patient with mesenteric vascular insult may result in frank bowel necrosis or in extension of the ischemia, resulting in a protracted postoperative course and eventually death. Papandria et al. found that delay to appendectomy is associated with increased perforation rates in children and adults . This finding concurs Methocarbamol with previous studies and with the conventional progressive pathophysiologic appendicitis model. On the other hand, Eko et al. found that timing of
surgery for acute appendicitis did not affect the incidence of complications including perforation. However, in that study, delay in surgical consultation and treatment was associated with increased length of hospital stay and increased hospital costs. The investigators concluded that optimal timing of appendectomy for uncomplicated acute appendicitis appears to be within 18 hours of emergency department presentation . In contrast, Abou Nukta et al. claimed that delaying appendectomy for 12–24 hours does not have a significant effect on perforation rate, operative time or length of hospital stay . In an attempt to clarify the risk of surgical delay in acute appendicitis the ACS National Surgical Quality Improvement Program (ACS NSQIP) database was reviewed . The primary outcomes were 30-day overall morbidity and 30-day serious morbidity and mortality.