(D)Elayed vs. (E)Arly (L)Aparoscopic (A)Ppendectom(Y)

NCT ID: NCT03524573

Last Updated: 2023-11-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

127 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-11-05

Study Completion Date

2023-03-30

Brief Summary

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The DELAY Trial will compare immediate (\< 6 hours from decision to operate) to delayed (Surgery to take place the following morning) appendectomy in adult patients presenting to the emergency department with suspected acute appendicitis. The primary outcome will be 30 day postoperative complications.

Detailed Description

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This randomized controlled trial is designed to assess the effect of timing of surgery on surgical complications in patients undergoing appendectomy for acute appendicitis at one of two participating institutions.

Early appendectomy in patients diagnosed with acute appendicitis has been a mainstay of treatment. Timely intervention is recommended to avoid the risks associated with perforated appendicitis, which has been shown to increase the risk of post-operative complications compared to non-perforated appendicitis. However, some studies have suggested that delaying appendectomy does not increase complications. Several studies have also assessed the safety of nighttime operating with conflicting results. Some suggest that delaying surgery until daytime is safe.

This study is a prospective, randomized controlled trial with blinding of the outcome assessors. Eligible participants will be adult patients diagnosed with acute appendicitis with an expected operative start time between 2000-0400. Patients randomized to the intervention group will have delayed surgery after 0530 the following morning to avoid nighttime operating. Patients randomized to the control group will receive immediate surgery within 6 hours of the decision to operate. The follow up period will be a minimum of 30 days. Independent outcome assessors will assess patients during their postoperative course in hospital as well as in the outpatient follow up clinic.

The primary outcome for this study is complication occurring within 30 days of surgery. Complication includes any of the following: mortality, readmission to hospital, emergency department (ED) visit, percutaneous drain insertion, reoperation, prolonged hospital stay greater than 7 days, and a predefined list of postoperative complications. Secondary outcomes include perforated appendicitis, operative time, and length of stay.

Conditions

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Appendicitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized Controlled Trial
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Outcome assessors will be blinded to the intervention.

Study Groups

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Delayed Appendectomy

Patients will undergo appendectomy the morning following the decision to operate. This group will have an anticipated delay between 3 - 14 hours from the decision to operate, with a surgical start time between 0530 - 0900.

Group Type EXPERIMENTAL

Appendectomy

Intervention Type PROCEDURE

Appendectomy is the surgical removal of the appendix.

Immediate Appendectomy

Patients will undergo appendectomy within 6 hours of the decision to operate. Surgery will take place between 2000 - 0400.

Group Type ACTIVE_COMPARATOR

Appendectomy

Intervention Type PROCEDURE

Appendectomy is the surgical removal of the appendix.

Interventions

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Appendectomy

Appendectomy is the surgical removal of the appendix.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Adult patients ≥ 18 years of age
* Imaging confirmed diagnosis of appendicitis (ultrasound or CT or MRI)
* Expected time of operation between 2200 - 0400 and occurs within 6 hours of the decision to operate

Exclusion Criteria

* Patients with hemodynamic instability
* Patients with suspected sepsis
* Unknown diagnosis
* Presence of abscess on CT Scan
* Diagnosis of missed appendicitis
* Pregnancy
* Patients who are not surgical candidates
* Patients who are not competent to sign consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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London Health Sciences Centre

OTHER

Sponsor Role collaborator

Queen's University

OTHER

Sponsor Role lead

Responsible Party

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Sunil Patel

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Kingston Health Sciences Centre

Kingston, Ontario, Canada

Site Status

Countries

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Canada

References

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Patel SV, Zhang L, Mir ZM, Lemke M, Leeper WR, Allen LJ, Walser E, Vogt K. Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial. Ann Surg. 2024 Jan 1;279(1):88-93. doi: 10.1097/SLA.0000000000005996. Epub 2023 Jul 13.

Reference Type BACKGROUND
PMID: 37436871 (View on PubMed)

Other Identifiers

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SURG-402-17

Identifier Type: -

Identifier Source: org_study_id

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