24-hour delay may be safe for surgical intervention in patients with uncomplicated appendicitis

1. Operating within 24 hours was non-inferior to operating within 8 hours among patients diagnosed with uncomplicated appendicitis with respect to the risk of appendiceal perforation.

2. There were no reported deaths in either group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Appendicectomy, or appendectomy, is the standard treatment for appendicitis, yet no consensus exists on the optimal surgical timing for acute uncomplicated appendicitis. While some studies suggest that longer in-hospital delays may be non-inferior to shorter delays, further research is needed. This randomized controlled trial aimed to compare the rate of appendiceal perforation in patients who undergo unplanned appendicectomy within 8 hours versus 24 hours. The primary outcome was the rate of appendiceal perforation, while key secondary outcomes were the rate of complications within 30 days. According to study results, appendicectomy within 24 hours did not increase the risk of appendiceal perforation versus scheduling it within 8 hours. Although this study was well done, it was limited to specific centers in Finland and Norway, affecting the generalizability to other healthcare systems.

Click to read the study in The Lancet

Relevant Reading: A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

In-depth [randomized-controlled trial]: Between May 18, 2020, and Dec 31, 2022, 2095 patients were screened for eligibility across three hospitals in Finland and Norway. Included were patients ≥ 18 years old with uncomplicated acute appendicitis, excluding those with signs of perforation, fever, high C-reactive protein, and complicated appendicitis on imaging. Altogether, 1805 patients (907 in the 8h group and 896 in the 24h group) were included in the final analysis. The primary outcome of this study indicated that scheduling appendicectomy within 24 hours was non-inferior to scheduling it within 8 hours in terms of the rate of appendiceal perforation (9% in <24h group vs. 8% in <8h group, 95% confidence interval [CI] -2.1 to 3.2, p=0.68, risk ratio 1.065). The secondary outcome showed no significant difference in complication rates within 30 days between both groups (6% in the <24h group vs. 7% in the <8h group, p=0.39). Additionally, total operating time and rates of conversion to open surgery were similar between groups. Findings from this study suggest that delaying appendicectomy for up to 24 hours does not increase the risk of appendiceal perforation in patients with uncomplicated appendicitis, allowing for better allocation of operating room resources.

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