Safety of in-hospital delay of appendectomy in complicated appendicitis - a propensity score-matched analysis of 1027 patients.
- 1Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, Augsburg, 86156, Germany. [email protected].
- 2Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, Augsburg, 86156, Germany.
- 3Department of Computational Statistics and Data Analysis, Institute of Mathematics, University of Augsburg, Augsburg, Germany.
Abstract
Introduction
Appendectomy is one of the most frequently performed emergency surgical procedures worldwide. Current guidelines recommend surgical intervention within 24 h for uncomplicated appendicitis; however, the optimal timing for patients with complicated appendicitis remains unclear. Recent studies suggest that in-hospital delay may be safe in uncomplicated cases, yet patients with clinical or radiological signs of perforation are usually excluded. This study aims to identify clinical and laboratory risk factors for perforation and to evaluate whether it is safe to delay surgery by 6 to 9 h in patients presenting with signs of complicated appendicitis.Methods
This retrospective single-center study included patients who underwent emergency surgery for complicated appendicitis between January 2008 and June 2023. Perforation was defined histopathologically, and complications were recorded perioperatively. Multivariable logistic regression was used to identify independent risk factors for perforation and complications. Propensity-score (PS) matching was performed to control confounding factors.Results
A total of 1,027 patients with suspected complicated appendicitis were included. PS matching yielded two cohorts of 327 patients. No significant differences were observed in perforation rates (46.5% vs. 47.1%; p = 0.88) or complication rates (23.5% vs. 21.4%; p = 0.51). Logistic regression analysis of the PS matched groups confirmed that a delay of surgery of > 6 h was not associated with increased risk of perforation (OR 1.03; 95% CI 0.75-1.41; p = 0.87) or complication rate (OR 0.87; 95% CI 0.59-1.27; p = 0.47). A 9-hour threshold to surgery showed no significant differences in perforation rates (50.0% vs. 44.9%; p = 0.34) or complication rates (24.7% vs. 19.7%; p = 0.25). Logistic regression analysis did not demonstrate an association between a surgical delay of > 9 h and either perforation (OR 0.79; 95% CI: 0.51-1.22; p = 0.28) or complication rate (OR 0.68; 95% CI: 0.39-1.17; p = 0.16). Age > 65 years, higher BMI, symptom duration > 48 h at the time of admission, elevated inflammatory markers, and suspected perforation on imaging were identified as independent risk factors for perforation. Higher ASA scores, male sex, suspected perforation on imaging, and elevated CRP levels were associated with increased complication rates.Interpretation
A delay in surgical intervention of 6-9 h may be acceptable in patients with suspected complicated appendicitis without increasing the risk of perforation and / or complications.
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BibTeX
@article{anthuber2026safety,
title = {{Safety of in-hospital delay of appendectomy in complicated appendicitis - a propensity score-matched analysis of 1027 patients.}},
author = {Lena Anthuber and Michael Hoffmann and Stefan Schiele and Gernot Müller and Andrea Mair and Florian Sommer and David Pinto and Matthias Anthuber and Katharina Beyer and Matthias Schrempf},
journal = {Langenbeck's archives of surgery},
year = {2026},
month = oct,
doi = {10.1007/s00423-026-04264-3},
url = {https://europepmc.org/article/MED/42909648},
note = {CC BY},
}
RIS
TY - JOUR
TI - Safety of in-hospital delay of appendectomy in complicated appendicitis - a propensity score-matched analysis of 1027 patients.
AU - Lena Anthuber
AU - Michael Hoffmann
AU - Stefan Schiele
AU - Gernot Müller
AU - Andrea Mair
AU - Florian Sommer
AU - David Pinto
AU - Matthias Anthuber
AU - Katharina Beyer
AU - Matthias Schrempf
PY - 2026
DA - 2026/10/23
JO - Langenbeck's archives of surgery
DO - 10.1007/s00423-026-04264-3
UR - https://europepmc.org/article/MED/42909648
AB - Introduction Appendectomy is one of the most frequently performed emergency surgical procedures worldwide. Current guidelines recommend surgical intervention within 24 h for uncomplicated appendicitis; however, the optimal timing for patients with complicated appendicitis remains unclear. Recent studies suggest that in-hospital delay may be safe in uncomplicated cases, yet patients with clinical or radiological signs of perforation are usually excluded. This study aims to identify clinical and laboratory risk factors for perforation and to evaluate whether it is safe to delay surgery by 6 to 9 h in patients presenting with signs of complicated appendicitis.Methods This retrospective single-center study included patients who underwent emergency surgery for complicated appendicitis between January 2008 and June 2023. Perforation was defined histopathologically, and complications were recorded perioperatively. Multivariable logistic regression was used to identify independent risk factors for perforation and complications. Propensity-score (PS) matching was performed to control confounding factors.Results A total of 1,027 patients with suspected complicated appendicitis were included. PS matching yielded two cohorts of 327 patients. No significant differences were observed in perforation rates (46.5% vs. 47.1%; p = 0.88) or complication rates (23.5% vs. 21.4%; p = 0.51). Logistic regression analysis of the PS matched groups confirmed that a delay of surgery of > 6 h was not associated with increased risk of perforation (OR 1.03; 95% CI 0.75-1.41; p = 0.87) or complication rate (OR 0.87; 95% CI 0.59-1.27; p = 0.47). A 9-hour threshold to surgery showed no significant differences in perforation rates (50.0% vs. 44.9%; p = 0.34) or complication rates (24.7% vs. 19.7%; p = 0.25). Logistic regression analysis did not demonstrate an association between a surgical delay of > 9 h and either perforation (OR 0.79; 95% CI: 0.51-1.22; p = 0.28) or complication rate (OR 0.68; 95% CI: 0.39-1.17; p = 0.16). Age > 65 years, higher BMI, symptom duration > 48 h at the time of admission, elevated inflammatory markers, and suspected perforation on imaging were identified as independent risk factors for perforation. Higher ASA scores, male sex, suspected perforation on imaging, and elevated CRP levels were associated with increased complication rates.Interpretation A delay in surgical intervention of 6-9 h may be acceptable in patients with suspected complicated appendicitis without increasing the risk of perforation and / or complications.
SN - 1435-2443
SN - 1435-2451
ER -