Effect of in-hospital delay on acute appendicitis severity: Does time really matter?

Abstract text (incl. references and figure legends)

Introduction

Appendicitis is one of the most common abdominal emergencies. Evidence is controversial in determining if the in-hospital time delay to surgery can worsen the clinical presentation of appendicitis, with a larger proportion of complicated appendicitis and subsequent increased morbidity. This study aimed to clarify if in-hospital surgical delay significantly affected the proportion of complicated appendicitis in a large prospective cohort of patients treated with appendectomy for acute appendicitis.

Materials and Methods

This is an analysis of a prospectively collected register of all consecutive patients treated with appendectomy at our center for acute appendicitis between 2013-2021. Patients were stratified according to the Alvarado score predicted risk of acute appendicitis: the low risk group included patients with a score from 0 to 3, medium risk from 4 to 6 and high risk from 7 to 10. Appendicitis were defined as complicated in case of perforated and necrotic appendicitis, peritoneal abscess or peritonitis. The primary outcome was correlation of in-hospital delay with the proportion of complicated appendicitis.

Results

The study included 916 patients: 559 were male (61%) and median age was 24 (14-46). 278 (30.4%) had complicated appendicitis. Median time delay to surgery was 19.6 hours (11.2-30.3) for the uncomplicated appendicitis group and 19.3 hours for the complicated group. In each Alvarado risk group in-hospital delay to surgery was not associated with the presence of complicated appendicitis [OR(CI 95%) low risk: 1.002(0.994-1.009); medium risk: 1.005(0.994-1.016); high risk: 1.004(0.982-1.025)]. No significant correlation was observed between time delay and severity of complications, using Clavien Dindo Classification and Comprehensive Complication Index.

Conclusions

In-hospital delay was not associated with an increased proportion of complicated acute appendicitis.

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