Associations Between Time‐To‐Surgery and Postoperative Length of Stay and Complications in Patients With Acute Appendicitis
Anne Haff Jepsen, Emil Ørskov Ipsen, Katrine Folmann Finne, Rasmus Linnebjerg Knudsen, Rikke Helene Frølund Bjulf, Aurelien‐Xuan R. Bahuet, Claus Anders Bertelsen, Kai Henrik Wiborg Lange, Anders Peder Højer Karlsen, Markus Harboe Olsen, Jakob Kleif, Lars Hyldborg Lundstrøm, Anders Kehlet NørskovABSTRACT
Introduction
Acute appendicitis is a common surgical emergency. The optimal time‐to‐surgery interval remains debated, as studies reported increased complication risk beyond 12 or 24 hours respectively. We hypothesized that time‐to‐surgery of up to 24 hours after admission was not associated with increased postoperative length of stay (LOS) or complications.
Methods
This retrospective observational cohort study included adults and adolescents (≥ 15 years) undergoing laparoscopic appendectomy from January 2017–July 2025 in the Capital and the Zealand Regions of Denmark. Data were extracted from the Electronic Health Record system. The primary exposure was time‐to‐surgery intervals. Primary outcome was postoperative LOS. Secondary outcomes were 30‐day postoperative complications. Subgroup analyses were performed for uncomplicated/complicated appendicitis. All outcomes were evaluated by multivariable regression models adjusted for predefined confounders.
Results
Of 25,417 laparoscopic appendectomies, 19,089 met eligibility criteria. Compared with time‐to‐surgery < 8 hours, postoperative LOS was reduced when time‐to‐surgery was 8–16 hours (mean difference −2.29 hours, 95% CI: −3.85 to −0.73) and 16–24 hours (−3.92 hours, 95% CI: −6.05 to −1.78). Compared with time‐to‐surgery < 8 hours, odds of postoperative complications were reduced for time‐to‐surgery up to 24 hours, whereas ≥ 36 hours was associated with increased odds (OR 1.57, 95% CI: 1.13 to 2.18). In complicated appendicitis, time‐to‐surgery 24–36 hours was associated with decreased postoperative LOS (−13.0 hours, 95% CI: −22 to −3.6).
Conclusion
Time‐to‐surgery of up to 24 hours was not associated with increased postoperative LOS or complications. In contrast, we observed a protective association driven by complicated appendicitis, potentially reflecting effective clinical triage.