Clinical Outcomes of Delayed Versus Immediate Source Control in Intra-Abdominal Sepsis Presenting to the Emergency Department: A Systematic Review

Background: The clinical impact of delayed source control in intra-abdominal sepsis is difficult to quantify because of heterogeneity in timing definitions, infection sources, and procedural approaches. This review evaluated delayed versus immediate or early source control mortality and other clinical outcomes in adults with intra-abdominal sepsis. Methods: PubMed, Scopus, Web of Science, and Embase were searched from inception to January 2026. Eligible studies compared early with delayed operative, percutaneous, or endoscopic source control, or assessed time to intervention. Risk of bias was evaluated using ROBINS-I. Random-effects meta-analyses pooled odds ratios for mortality when studies were comparable. Results: Seven observational studies including 1,835 participants were included; three contributed to quantitative synthesis. Delayed drainage was associated with higher in-hospital mortality in the adjusted meta-analysis (pooled OR 2.92, 95% CI 1.51–5.66; I²=0%). In the harmonized comparison of source control after versus within 12 hours, the random-effects estimate was not significant (OR 1.92, 95% CI 0.44–8.39) and heterogeneity was substantial (I²=87.8%). Individual studies suggested worse outcomes with prolonged delay, although findings varied by source, threshold, and comparator. Conclusion: Delayed source control increase mortality in biliary sepsis, but current evidence does not support a universal timing threshold. Prompt source control is clinically important, while better standardized prospective studies are needed.