5 Predictors for Appendicectomy Operative Severity and Outcomes

Abstract Background WSES 2020 guidelines recommend surgery within 8 hours for complicated appendicitis and allow up to 24 hours’ delay for uncomplicated cases. Recent evidence also supports preoperative CT and postoperative colonic evaluation in patients >40 years old. Aim: We audited our appendicectomy practice against these recommendations, assessing the impact of in-hospital delay and identifying predictors of complicated operative findings. Method A retrospective review of appendicectomies over eight months (Jan–Aug 2024) was conducted. Patients were grouped by decision-to-incision time: <8 hours, 8–24 hours, and >24 hours. Complicated findings included perforation, gangrene, or widespread peritonitis. Primary outcomes were severity of findings, operative time, length of stay (LOS), and morbidity. Secondary outcomes included predictors of complicated findings. Statistical analysis was performed using Chi-square, binary logistic regression, and one-way ANOVA (SPSS v22). Results 198 patients were included (median age 32). CT was used in 74% of cases. No significant differences were found between timing groups in complication rates, operative findings, or 30-day readmissions. LOS increased slightly with delay but was not statistically significant (P=0.077). Predictors of complicated appendicitis included fever, CRP >100 (P<0.0001), isolated hyperbilirubinemia (P=0.004), and CT-confirmed complications (P<0.0001). Negative appendicectomy rate was 10.6%; one malignancy (0.5%) was identified. Of 60 patients aged >40, only 4 were planned for colonoscopy. Conclusions Delayed appendicectomy (up to 24 hours) appears safe in uncomplicated cases. Early surgery and prioritisation should be considered for patients with predictors of severity. Colonic assessment in older patients remains underutilised.