Abstract
Background
We aimed to investigate the association between time from admission to appendectomy
on perioperative outcomes in order to determine optimal time-to-surgery windows.
Methods
We performed a retrospective review of all the appendectomies performed between July
2018 to May 2020. We first compared the perioperative outcomes using preselected time-to-surgery
cut-offs, then determined optimal safe windows for surgery, and finally identified
subgroups of patients who may require early intervention.
Results
Six hundred twenty-one appendectomies were performed in the time period. The patients
with a time-to-surgery of ≥12 hours had a significantly longer length of stay (median
2 days [interquartile range 1–3] vs 3 days [interquartile range 2–4], mean difference =
0.74 [95% confidence interval 0.32–1.17, P = .0006]) and higher 30-day readmission risk (odds ratio 2.58, 95% confidence interval
1.12–5.96, P = .0266) versus those with a time-to-surgery of <12 hours. These differences persisted
when the time-to-surgery was dichotomized by <24 or ≥24 hours. A time-to-surgery beyond
25 hours was associated with a 3.34-fold increased odds of open conversion (P = .040), longer operation time (mean difference 15.8 mins, 95% confidence interval
3.4–28.3, P = .013) and longer postoperative length of stay (mean difference 10.3 hours, 95%
confidence interval 3.4–20.2, P = .042) versus a time-to-surgery of <25 hours. The patients with time-to-surgery
beyond 11 hours had a 1.35-fold increased odds of 30-day readmission (95% confidence
interval 1.02–5.43, P = .046) compared with those who underwent appendectomy before 11 hours. Older patients,
patients with American Society of Anesthesiologist score II to III, and individuals
with long duration of preadmission symptoms had higher risk of prolonged operation
time, open conversion, increased length of stay, and postoperative morbidity with
increasing time-to-surgery.
Conclusion
This study identified the safe windows for appendectomy to be 11 to 25 hours from
admission for most perioperative outcomes. However, certain patient subgroups may
be less tolerant of surgical delays.
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Article info
Publication history
Published online: July 15, 2022
Accepted:
April 9,
2022
Footnotes
Tousif Kabir and Nicholas L. Syn contributed equally.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
