Journal of Gastrointestinal Surgery

, Volume 23, Issue 1, pp 210–223 | Cite as

Effect of Delay to Operation on Outcomes in Patients with Acute Appendicitis: a Systematic Review and Meta-analysis

  • Jian LiEmail author
  • Run Xu
  • Deng-Min Hu
  • Yao Zhang
  • Tu-Ping Gong
  • Xue-Lian Wu
Review Article



Many studies have investigated the association between time interval and incidence of complicated appendicitis and post-operative surgical site infection (SSI), but the results are controversial.


A systematic search of the electronic databases identified studies that investigated the association of appendectomy delay with complicated appendicitis and SSI among patients with acute appendicitis. Qualitative and quantitative meta-analysis of the results was conducted.


Twenty-one studies were included in the final analysis. Meta-analysis showed no significant difference in complicated appendicitis incidence between patients in the 6–12 h, > 12 and < 6 h groups (OR 1.07, 95% CI 0.89–1.30, p = 0.47; OR 1.04, 95% CI 0.88–1.22, p = 0.64). Comparison of the 6–12 h category with the < 6 h category of in-hospital delay revealed significant associations between longer in-hospital delay and increased risk of post-operative SSI (OR 1.40, 95% CI 1.11–1.77, p = 0.004). Patients in the 24–48 h category had 1.99- and 1.84-fold (p < 0.05) higher odds of developing complicated appendicitis compared to patients in the < 24 h category for pre-hospital delay and total delay, respectively (OR 1.99, 95% CI 1.35–2.94, p = 0.0006; OR 1.84, 95% CI 1.05–3.21, p = 0.03). When pre-hospital and total delay time extended to more than 48 h, the odds of risk increased 4.62- and 7.57-fold, respectively (OR 4.62, 95% CI 2.99–7.13, p < 0.00001; OR 7.57, 95% CI 6.14–9.35, p = < 0.00001).


Complicated appendicitis incidence was associated with overall elapsed time from symptom onset to admission or operation; short appendectomy in-hospital delay did not increase the risk of complicated appendicitis but was associated with a slightly increased risk of SSI. Prompt surgical intervention is warranted to avoid additional morbidity, enabling quicker recovery in this population.


Acute appendicitis Appendectomy Delay Surgical site infection 



We thank all the authors of studies included in this review. The authors would also like to thank the Health and Family Planning Commission of Mianyang City for their support.

Authors’ Contributions

Jian Li and Run Xu designed the study. Jian Li was directly involved in the full implementation of this study and was a major contributor in writing the manuscript. Deng-Min Hu, Yao Zhang, and Jian Li were jointly involved in studies collection, quality assessment, and data extraction. Tu-Ping Gong, Xue-Lian Wu, and Jian Li provided substantial contributions to the data analysis. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Competing Interests

The authors declare that they have no competing interests.

Ethics Statement

This systematic review and meta-analysis accomplished all of the ethics requirements according to the Helsinki declaration and all international statements.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Department of General SurgeryThe Third Hospital of Mianyang, The Mental Health Center of SichuanSichuanChina

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