Temporal Considerations in the Operative Management of Acute Appendicitis: A Review of Current Practices in a Tertiary Center in Australia

Background and aimTimely appendectomy is a cornerstone of the management of acute appendicitis, as delays may adversely affect patient outcomes and increase costs.This study aimed to assess the impact of operating room delays among patients with acute appendicitis. MethodsA retrospective review was conducted of patients who underwent appendectomy for suspected acute appendicitis between February and April 2025 at a tertiary hospital in Adelaide, Australia.Statistical analysis was completed to compare operative timing, findings, and length of stay (LOS). ResultsA total of 76 consecutive appendectomies from the study period were included.The median age was 37 years.Seventy percent of operations were completed in hours (08:00-17:00).A total of 59.2% of patients were delayed beyond their triage category due to hospital factors (triaged as within 4, 12, or 24 h).A total of 16 (21.1%)patients had perforated appendicitis, and there was no statistically significant difference in the proportion of perforated cases between delayed (20%) and non-delayed cases (22.6%).Non-perforated cases had a median time from operation to discharge of 21 h (IQR: 15-24) with total median LOS of three days (IQR: 2-4) (p=0.002), while perforated cases had an extended stay, with a median of 74 h (IQR: 39-91) (p<0.001) and total LOS of five days (IQR: 3.8-5.3)(p=0.002).The median LOS for delay cases was four days (IQR: 3-5), whereas the median LOS for non-delay cases was only two days (IQR: 2-3) (p<0.001).Hence, delaying cases resulted in a median longer total LOS of two days. ConclusionThis study highlights the acuity, caseload, and challenges associated with adhering to guidelines in a tertiary hospital in Adelaide.Delays in transfer to the operating room were associated with increased LOS, which may increase healthcare costs.Potential strategies to decrease LOS can include increasing availability of elective lists for emergent cases, which would prevent delays and improve healthcare utilization.Further studies should also complete a cost-benefit analysis of increasing operating theatre availability and reducing time to surgery.A larger sample size is required to evaluate the impact of delayed operations on perforation, complication, and readmission rates and LOS.