Factors influencing surgical management of acute appendicitis in a large university hospital without a dedicated emergency theatre

  • Megan Power FoleyEmail author
  • Michael MacLean
  • Ciaran Doyle
  • Timothy Nugent
  • Michael E. Kelly
  • Fady Narouz
  • Brian Mehigan
  • Paul McCormick
  • John Larkin
Original Article



Acute appendicitis is the most common surgical emergency. Its management reflects the efficacy of acute care surgery. Limited theatre space is an escalating issue, especially without dedicated emergency theatre access. Pre-operative delays are associated with longer length of stay, higher costs and post-operative complications.


Calculate time to theatre (TTT) from admission to appendicectomy and investigate factors impacting TTT.


A retrospective review of all emergency appendicectomies from June 2017 to October 2018. Demographic, clinico-pathological and radiological data were extracted from electronic patient record.


One hundred forty-eight patients underwent emergency appendicectomy during the study period. Fifty-six percent (n = 84) were male, and the median (range) age was 30.5 (17–76) years. Sixty-one percent had pre-operative imaging. The median (range) TTT was 18.37 (2–114) h; 7.5% (n = 11) waited > 48 h, 29.7% (n = 44) were operated on after 8 p.m. and 26% (n = 38) were done on elective lists. Male gender, admission CRP > 100 and admission before 12 p.m. significantly shortened TTT (p = 0.030, p = 0.004 and p = 0.001, respectively). However, pre-operative ultrasound, previous acute appendicitis and surgery on an elective list significantly prolonged TTT (p = 0.015 and p = 0.024, respectively). The median (range) LOS was 3 (1–24) nights. Ten percent (n = 15) had post-operative complications; however, longer TTT was not associated with higher complication rates (p = 0.196).


This review highlights the impact of limited theatre access for on-call emergency admissions, with a significant portion of appendicectomies being done on elective lists or out-of-hours.


Acute appendicitis Emergency surgical care Surgical management Surgical outcomes 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This study was a retrospective clinical audit, comparing our institution’s practice to published international standards. No new interventions were performed.


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Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Department of Colorectal & General SurgerySt. James’ HospitalDublin 8Ireland
  2. 2.School of Medicine, Trinity CollegeUniversity of DublinDublin 2Ireland

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