To evaluate whether an in-hospital surgical delay greater than 8 hours is associated with an increased incidence of postoperative complications in adult patients undergoing surgery for complicated acute appendicitis. An observational ambispective cohort study was conducted at a high-complexity referral hospital between January 2019 and March 2023. Adult patients with histopathologically confirmed complicated acute appendicitis were included and categorized according to in-hospital surgical delay greater than 8 hours or 8 hours or less. Postoperative complications during the index hospitalization were compared between groups. Relative risks with 95 percent confidence intervals were calculated. A total of 364 patients were included, with 182 patients in each cohort. The overall incidence of postoperative complications was higher in patients with a surgical delay greater than 8 hours compared with those operated on within 8 hours (15.38% vs 3.85%; RR 4.00, 95% CI 1.82–8.80; p < 0.001). Delayed surgery was associated with increased rates of surgical site infection (7.69% vs 1.65%; RR 4.66, 95% CI 1.36–15.98), intra-abdominal abscess (8.24% vs 1.65%; RR 4.99, 95% CI 1.48–16.86), and surgical reintervention (10.99% vs 3.85%; RR 2.86, 95% CI 1.24–6.58). No significant differences were observed in intensive care unit admission or in-hospital mortality. In adult patients with complicated acute appendicitis, an in-hospital surgical delay greater than 8 hours may be associated with a higher incidence of postoperative complications. These findings should be interpreted with caution given the observational design and lack of multivariable adjustment, but they underscore the importance of minimizing avoidable in-hospital delays once the diagnosis has been established.
Araujo-Zelada et al. (Wed,) studied this question.