Effect of Delay to Operation on Outcomes in Patients with Acute Appendicitis: a Systematic Review and Meta-analysis

BackgroundMany studies have investigated the association between time interval and incidence of complicated appendicitis and post-operative surgical site infection (SSI), but the results are controversial.MethodsA systematic search of the electronic databases identified studies that investigated the association of appendectomy delay with complicated appendicitis and SSI among patients with acute appendicitis. Qualitative and quantitative meta-analysis of the results was conducted.ResultsTwenty-one studies were included in the final analysis. Meta-analysis showed no significant difference in complicated appendicitis incidence between patients in the 6-12h, >12 and<6h groups (OR 1.07, 95% CI 0.89-1.30, p=0.47; OR 1.04, 95% CI 0.88-1.22, p=0.64). Comparison of the 6-12h category with the <6h category of in-hospital delay revealed significant associations between longer in-hospital delay and increased risk of post-operative SSI (OR 1.40, 95% CI 1.11-1.77, p=0.004). Patients in the 24-48h category had 1.99- and 1.84-fold (p<0.05) higher odds of developing complicated appendicitis compared to patients in the<24h category for pre-hospital delay and total delay, respectively (OR 1.99, 95% CI 1.35-2.94, p=0.0006; OR 1.84, 95% CI 1.05-3.21, p=0.03). When pre-hospital and total delay time extended to more than 48h, the odds of risk increased 4.62- and 7.57-fold, respectively (OR 4.62, 95% CI 2.99-7.13, p<0.00001; OR 7.57, 95% CI 6.14-9.35, p=<0.00001).ConclusionComplicated appendicitis incidence was associated with overall elapsed time from symptom onset to admission or operation; short appendectomy in-hospital delay did not increase the risk of complicated appendicitis but was associated with a slightly increased risk of SSI. Prompt surgical intervention is warranted to avoid additional morbidity, enabling quicker recovery in this population.