• Itamar Ashkenazi, Abdel-Rauf Zeina, and Oded Olsha.
• Hillel Yaffe Medical Center, Hadera, Israel. i_ashkenazi@yahoo.com.
• Eur J Trauma Emerg Surg. 2022 Oct 1; 48 (5): 3879-3886.

PurposeCurrent practice allows for surgery for acute appendicitis to be delayed up to 24 h in the belief that there will be no increase in complicated appendicitis rates. We evaluated the combined effect of Patient Time (between symptom onset and hospital admission) and Hospital Time (between hospital admission and surgery) on the surgical outcome. We hypothesized that in patients with a short Patient Time, increased Hospital Times will be associated with a higher rate of complicated appendicitis, even in patients operated within 24 h.MethodsRetrospective evaluation of medical files of patients operated for acute appendicitis between 12/2006 and 12/2016.ResultsOf 2749 patients with acute appendicitis included in this analysis, 818 (29.8%) were admitted with symptom onset the same day as admission, 577 (21.0%) reported symptom onset had started the previous day but less than 24 h before admission, and 1354 (49.3%) had over 24 h of symptoms. In patients with symptom onset the same day, a gradual increase in the rate of complicated appendicitis was noted with increasing Hospital Times (≤ 6 h-6.3%; 6-12 h-9.9%; 12-18 h-14.7%; and 18-24 h-12.7%; p = 0.017). In all other patients no differences in the rate of complicated appendicitis were noted as long as the patients were operated within 24 h of admission.ConclusionIn patients with a short Patient Time, delaying operation is associated with an increased rate of complicated appendicitis and this group of patients should be prioritized for early surgery.Clinical TrialsStudy registered as ClinicalTrials.gov Identifier: NCT04689906 ( https://clinicaltrials.gov/ct2/show/NCT04689906?term=ashkenazi+itamar&draw=2&rank=2 ).© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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