Does the time from symptom onset to surgery affect the outcomes of patients with acute appendicitis? A prospective cohort study of 255 patients

Introduction: The objective of this study was to evaluate the impact of operative timing on outcomes of acute appendicitis. Methods: This study examined adult patients who had presented to the hospital with acute appendicitis and had undergone appendectomy from December 2017 to February 2019. Time delay and outcomes of perforated and non-perforated appendicitis were compared. Patients were classified into five groups based on the period from symptom onset to operation: group 1, <24 hours; group 2, >= 24 and <48 hours; group 3, >= 48 and <72 hours; group 4, >= 72 and <96 hours; and group 5, >= 96 hours. The five groups were compared, with risk of perforation assessed in particular. Results: A total of 255 patients were included in the analysis. Symptom duration, operative time, and length of postoperative hospital stay (P< .001) were significantly longer in the perforated group (n = 49) than in the non-perforated group (n = 206). The perforated group also had a higher conversion rate to open procedures (P= .002) and a higher rate of wound infection (P= .034). Group 1 had 53 patients, group 2 had 95 patients, group 3 had 57 patients, group 4 had 32 patients, and group 5 had 18 patients. The incidence of appendiceal perforation and median operative time progressively increased along with symptom duration in the five groups. In multivariate analyses, independent risk factors for appendiceal perforation were male gender (odds ratio = 2.33, 95% confidence interval [CI]: 1.07-5.08) and symptom duration >= 48 hours (relative to >= 24 and <48 hours) (odds ratio = 4.64, 95%CI: 1.76-12.27). Patients with symptom duration >= 72 hours had a significantly longer operative time than those with symptom duration >= 48 and <72 hours (beta = 21.38, 95%CI: 5.66-37.11,P= .008). Conclusion: The risk of perforation increased significantly 48 hours after the onset of appendicitis. Symptoms duration >= 72 hours was associated with a longer operative time.