Time to surgery for acute uncomplicated appendicitis in an adult university teaching hospital

Aims: Both patient and hospital-related factors determine the timing of appendicectomy for acute uncomplicated appendicitis. Recent literature suggests appendicectomy more than 24 h after hospital admission is associated with increased morbidity in adults. Current guidelines from the World Society of Emergency Surgery (WSES) recommend surgery within this timeframe to reduce the risk of complications. The aim of this study was to determine the time to surgery for patients with acute uncomplicated appendicitis and to compare this to the current WSES recommendations. This study also aimed to identify potential reasons for any in-hospital delay.

Methods: This study is a retrospective review of all patients who underwent appendicectomy for confirmed acute uncomplicated appendicitis at an adult university teaching hospital between September 2021 and September 2022. Patient demographics, clinical information, time of admission, time of surgery, time of discharge and surgical complication data were collected.

Results: A total of 229 appendicectomies were performed during the study period. 138 (60 %) had a preoperative diagnosis of acute uncomplicated appendicitis. The median age was 36 years (range 17-93). Time to surgery was <24 h in 80 (58 %) patients and >24 h in 58 (42 %) patients. In patients with a delay of >24 h, 28 (48 %) had their surgery 24-36 h after admission, 23 (40 %) had their surgery between 36 and 48 h, and 7 (12 %) had their surgery >48 h after admission. Patients who were operated >24 h after admission had a higher rate of readmission, 4/58 (6.9 %) compared to 1/80 (1.25 %) in the less than 24 h group (p = 0.09). Delays in radiology, surgical ward beds and the lack of a dedicated emergency theatre may have contributed to extended waiting times.

Conclusion: The results of this study show that the majority (58 %) of patients within our cohort were operated on within the WSES guidelines. However, 42 % of patients had their surgery in excess of these recommendations. Extended waiting periods may be related to delays in radiology, surgical ward beds and a lack of a dedicated emergency theatre. Patients who were operated on greater than 24 h following their admission also had a higher rate of readmission.