Vol. 5, Issue 2, Part A (2023)

Background: Complex appendicitis, which includes perforation, abscess formation, or peritonitis, is associated with substantial clinical difficulties that carry a higher risk of morbidity and mortality with delayed surgical intervention. Optimal timing for surgical intervention, following initial treatment has been debated in the field of emergency surgery.
Objective: To identify the effects of delayed surgical intervention on patient outcomes with complicated appendicitis including length of stay, complications and mortality.
Methods: This study was designed as a retrospective cohort study to identify the impact of delays in surgical intervention, or delayed timing, in those patients diagnosed with complicated appendicitis at a private hospital in Baghdad from January 2020 to December 2023. A total of 342 patients were identified for the cohort study and each was classified into either characteristics of medical and surgical intervention within 6 hours of diagnosis (early intervention) or > 6 hours from diagnosis (delayed intervention). Primary outcomes of the study were length of stay, any post-operative complications and 30-day mortality. Secondary outcomes included indwelling or surgical site infections, 30 day hospital re-admission and costs to the healthcare system.
Results: Of 342 patients, 198 (57.9%) entered into the early intervention group and 144 (42.1%) entered into the delayed intervention group. Length of hospital stay was significantly longer (8.3±3.2 vs 5.8±2.4 days, p<0.001) in the delayed intervention group and a higher percentage of declared complications (34.7% vs 21.2%, p=0.008), and direct health care expenditure ($18450 ± $6200 vs $12300 ± $4100, p<0.001). The 30-day mortality rate in the delayed intervention group was also significantly higher (4.2% vs 1.5%, p=0.024). The incidence of infection was higher in the delayed intervention group (surgical site infection 18.1% vs 9.1%, p=0.019).
Conclusion: Delayed surgical intervention with appendicitis is associated with worse patient outcomes with potentially prolonged hospital stays, and higher complication rates and mortality. Therefore, surgical intervention in a timely fashion in complicated appendicitis, specifically at 6 hours from diagnosis would be encouraged in the future to positively impact patient outcomes.