IMPACT OF SURGICAL TIMING ON PEDIATRIC APPENDICITIS OUTCOMES: A RETROSPECTIVE ANALYSIS

Abstract

Moamen Abdelfadil Ismail*, Anas Khalid Alqahtani, Ali Omar Mohammed Alzahrani, Lujain Bandr Alothman, Emtenan Ali Arishi, Shatha Mohammed Faya Asiri, Salwa Mohammed Asiri, Osama Fahad Almabadi, Ziad Yan-allah alkathiri and Jood Majed Bamunef

Background: Acute appendicitis is one of the most common surgical emergencies in children. The optimal timing of surgery following diagnosis remains debated, with some advocating for immediate intervention while others support delayed appendectomy. This study examines whether surgical timing affects paediatric appendicitis outcomes, particularly in terms of perforation risk, postoperative complications, and hospital stay duration.

Methods: This retrospective study analyzed data from paediatric patients (0–15 years) who underwent appendectomy for suspected appendicitis. Patients were stratified into different groups based on the time elapsed between emergency department (ED) admission and surgery. Primary outcomes included histopathologic confirmation of perforated appendicitis. Secondary outcomes included rates of wound infection, intra-abdominal abscess, reoperation, readmission, and hospital stay length. Multivariate logistic regression analysis was used to adjust for potential confounders, such as inflammatory markers and symptom severity.

Results: Among 2,500 paediatric patients, 24% had histopathologic ally confirmed perforated appendicitis. Factors significantly associated with perforation included younger age, female sex, elevated body temperature, and increased inflammatory markers (CRP, WBC). Unadjusted analysis showed an inverse relationship between time to surgery and perforation risk, but adjusted models revealed no significant association between surgical delay and perforation. Delayed surgery was not linked to higher rates of wound infections, intra-abdominal abscesses, or readmissions. Notably, moderate surgical delays (24–36 hours) were associated with shorter hospital stays.

Conclusion: Surgical timing does not independently impact perforation risk or postoperative complications in paediatric appendicitis cases. These findings support the safety of delayed appendectomy in stable patients, emphasizing the importance of preoperative management, including fluid resuscitation and selective antibiotic use.