Non-perforated acute appendicitis, should it be managed as a surgical emergency to be operated at the same night of presentation or it can be delayed to the next day elective list?: a retrospective study

Background: The safety of delaying appendectomy had been widely debated in the surgical literature. Regardless patient related causes for delay like patients coming from rural areas, sometimes surgical management is delayed due to many causes like diagnostic uncertainty, lack of patient fasting, night presentation, patients with comorbidities who need special preparation, failed trial for management with antibiotics, and atypical picture of presenting symptoms. We conducted this study to evaluate safety of one night delay before surgery for non-perforated acute appendicitis.Patients and methods: Retrospective evaluation of 1942 patients older than 12 years with non-perforated acute appendicitis in the period between December 2019 and November 2023. We excluded patients with: diffuse peritonitis, pregnant women, negative appendectomy, incidental, interval appendectomy, combined surgery (with urologists, obstetricians, and gynecologists), operation after consultations from other departments, and patients with severe comorbidities requiring intensive care.Results: The study included 1127 (58.03 %) males and 815 (41.97 %) females with a mean age of 23.87±8.86 years. The classic migrating pain from periumbilical region to the right iliac fossa was present in 1107 (57%) patients. Patients were presented after 1-2.5 days following symptoms onset. The hospital interval which means time from ER admission till surgery "system time" ranged 9-24 hours. Superficial surgical site infection occurred in 136 (7%) patients while intra-abdominal fluid collection occurred in 13 (0.67%) patients with no mortality. Conclusion: Our study confirms and contributes additional evidence supporting that non-perforated acute appendicitis in selected patients is safe for surgical delay up to 24 hours under the administration of intravenous antibiotics. It is not a true surgical emergency that should be operated at the same night of presentation. The duration of patients’ symptoms before hospital presentation is the most important factor for final patients’ outcome rather than the system time of delay.