A Comparative Study of The Association between The Waiting Time for Appendectomy and Occurrence of Appendicitis Complications

Abstract

Background: Currently, there are research studies collecting data on delayed appendectomy compared to the group undergoing urgent surgery to study the effects of delayed surgery. The majority found no statistically significant difference. In addition, The World Journal of Emergency Surgery published the Jerusalem guidelines for appendicitis, which state that appendectomy for uncomplicated appendicitis within 24 hours does not differ in the occurrence of complications.  (QoE: 1B) Therefore, it is possible to study the appropriate waiting time for planning appendectomy treatment, reducing the burden of emergency surgery, and increasing treatment options for appendicitis.

Objective: To compare appendectomy outcomes at Hua Hin Hospital, dividing patients into groups based on the time after diagnosis: those who underwent surgery within 1 hour, 1-6 hours, 6-12 hours, and after 12 hours, to study the effect on the occurrence of complications.

Methods: This is a retrospective study collecting data from patients diagnosed with appendicitis at Hua Hin Hospital from January 1, 2021, to December 31, 2023, totaling 839 cases. Descriptive statistics were used, and for continuous data, statistical tests were used, including the Chi-square test, One-way ANOVA, Kruskal-Wallis test, Binary logistic regression, Poisson regression, Mann-Whitney U test, and Spearman rho correlation.

Results: The waiting time for appendectomy in the groups operated within 1 hour, 1-6 hours, and 6-12 hours showed no statistically significant difference in the occurrence of complications. However, the group operated after 12 hours had a statistically significant reduction in the chance of developing gangrenous appendicitis and ruptured appendicitis at the 0.05 level (Multivariable analysis). The effect of surgical waiting time on the occurrence of abscess and phlegmon was found to be statistically insignificant (P>0.05)

Conclusion: The waiting time for appendectomy in the groups operated within 1 hour, 1-6 hours, and 6-12 hours showed no statistically significant difference in the occurrence of complications, which is consistent with previous research.However, this study found that the group operated after 12 hours had a lower chance of developing gangrenous appendicitis and ruptured appendicitis compared to the group operating within 1 hour.