The Effect of Symptom/Waiting Periods and Appendectomy Timing on Clinical Outcomes in Patients with Appendectomy

Aim: To examine the effects of pre-hospital and pre-operative hospital time and timing of surgery on clinical outcomes in patients with acute appendicitis (AA). Method: Patients who underwent appendectomy between January 2015 and June 2020 were included. Demographic data, operation/anesthesia type, American Society of Anesthesiologists score, hospital admission times, hospital preparation time and total time (sum of duration of symptoms plus hospital preparation time), operation timing, peroperative findings and complications were evaluated. Results: In total 1,865 cases were reviewed. The mean duration of symptoms was 20.7 hours, the mean preparation time was 14.5 hours, and the mean total time was 35.2 hours. In terms of operation timing and complication rates these were: 25.6% between 08:00-16:00 (5% complication rate); 41.9% between 16:00-24:00 (3.1% complication rate) and 32.5% between 24:00-08:00 (5.9% complication rate). When evaluated in terms of duration of symptoms and complications, this period was longer in the group with complications (20.4 versus 37.4 hours). When evaluated in terms of total time, it was found that this period was significantly longer in patients who developed complications (34.8 hours vs 42.4 hours, p=0.004). Duration of symptoms ≥11.5 hours was significantly associated with the development of complications. Furthermore, the complication rate increased when the total time was ≥30.5 hours. Conclusion: The time from the onset of symptoms to appendectomy in AA is closely associated with the development of complications. Patients admitted to the hospital ≥11.5 hours after the onset of symptoms or operated ≥30.5 hours after symptom onset have an increased complication rate after appendectomy.