818 Acute Appendicitis: Why the Wait? – a Retrospective Analysis of Timings Associated with the Most Common Emergency General Surgery Operation

Aim Getting it right first time (GIRFT) analyses hospital data nationally, identifying areas to improve patient care. Their latest report suggests reducing appendicectomy length of stay (LOS) could result in significant cost savings, proposing a benchmark figure of 36.2% being discharged within two days. GIRFT data shows James Cook University Hospital discharges only 25.7%. Additionally, the World Society of Emergency Surgery recommends performing all emergency appendicectomies within 24 hours of admission. Our aim was to identify delays in patient care to meet these two standards. Method Emergency appendicectomies performed between 01/06/2021 and 30/05/2023 were included, with admission data for 354 patients being analysed. Calculations were performed to provide the following metrics: time to decision to operate, admission time to theatre arrival, time from decision to operate to theatre arrival, post-operative LOS; and total LOS. We further reviewed pre-operative imaging and histology to differentiate between uncomplicated and complicated appendicitis. Results 33.5% of patients were discharged within 48 hours of admission, with a median LOS of 2.4 days. 78.2% had an operation within 24 hours of admission. Median post-operative LOS was 1.4 days with a notably large third quartile (1.4 - 3.1). Within this quartile 60.7% were found to have uncomplicated or normal histology. Conclusions Our audit demonstrated a discrepancy from the GIRFT data; however, it identified opportunities to decrease LOS, especially in the uncomplicated appendicitis sub-group. It is important to remember that LOS is only one factor in providing high quality patient care, however, timely flow is important to running an effective emergency general surgery service.