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. 2024 Jun 14;19(1):24.
doi: 10.1186/s13017-024-00549-4.

The impact of timing on outcomes in appendicectomy: a systematic review and network meta-analysis

Gavin G Calpin  1   2 , Sandra Hembrecht  3   4 , Katie Giblin  4 , Cian Hehir  3 , Gavin P Dowling  4 , Arnold D K Hill  3   4
Affiliations

The impact of timing on outcomes in appendicectomy: a systematic review and network meta-analysis

Gavin G Calpin et al. World J Emerg Surg. .

Abstract

Introduction: Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes.

Aim: To perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed (2), time elapsed from symptom onset to hospital presentation (patient time) (3), time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes.

Methods: A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into < 24 h, 24-48 h and > 48 h. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed.

Results: Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were < 24 h. Readmission and mortality rates were significantly better when the hospital time was < 48 h. SSI, operative time, and the rate of perforation were comparable in all groups.

Conclusion: Appendicectomy within 24 h of hospital admission is associated with improved outcomes compared to patients having surgery 24-48 and > 48 h after admission. The time-of-day which surgery is performed does not impact outcomes.

Keywords: Appendicectomy; Appendicitis; Outcomes; Systematic review; Timing.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study identification
Fig. 2
Fig. 2
Forest plots comparing outcomes based on the time-of-day surgery was performed
Fig. 3
Fig. 3
Forest plot comparing outcomes based on patient time
Fig. 4
Fig. 4
Forest plots comparing outcomes based on hospital time
Fig. 5
Fig. 5
Operative time based on hospital time
Fig. 6
Fig. 6
Length of stay based on hospital time
Fig. 7
Fig. 7
Forest plots comparing outcomes based on total time
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