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Associations Between Time-To-Surgery and Postoperative Length of Stay and Complications in Patients With Acute Appendicitis.

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Τίτλος: Associations Between Time-To-Surgery and Postoperative Length of Stay and Complications in Patients With Acute Appendicitis.
Συγγραφείς: Jepsen AH; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerød, Denmark., Ipsen EØ; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerød, Denmark., Finne KF; Department of Surgery, Copenhagen University Hospital-North Zealand, Hillerød, Denmark., Knudsen RL; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerød, Denmark., Frølund Bjulf RH; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerød, Denmark., Bahuet AR; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerød, Denmark., Bertelsen CA; Department of Surgery, Copenhagen University Hospital-North Zealand, Hillerød, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Wiborg Lange KH; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerød, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Højer Karlsen AP; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital-Bispebjerg, Bispebjerg, Denmark., Olsen MH; Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital-Bispebjerg, Bispebjerg, Denmark.; Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.; Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark., Kleif J; Department of Surgery, Copenhagen University Hospital-North Zealand, Hillerød, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Lundstrøm LH; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerød, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Nørskov AK; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerød, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Πηγή: World journal of surgery [World J Surg] 2026 Sep; Vol. 50 (9), pp. 2609-2624. Date of Electronic Publication: 2026 Aug 06.
Τύπος έκδοσης: Journal Article; Observational Study
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Wiley Country of Publication: United States NLM ID: 7704052 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2323 (Electronic) Linking ISSN: 03642313 NLM ISO Abbreviation: World J Surg Subsets: MEDLINE
Imprint Name(s): Publication: 2024- : [Hoboken, NJ] : Wiley
Original Publication: New York, Springer International.
Ιατρικοί όροι (MeSH): Appendicitis*/surgery , Length of Stay*/statistics & numerical data , Appendectomy*/methods , Postoperative Complications*/epidemiology , Postoperative Complications*/etiology , Time-to-Treatment*/statistics & numerical data , Laparoscopy*, Denmark/epidemiology ; Humans ; Female ; Retrospective Studies ; Male ; Adult ; Adolescent ; Middle Aged ; Young Adult ; Acute Disease ; Time Factors
Περίληψη: 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.
(© 2026 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC). All rights reserved, including rights for text and data mining and training of artificial intelligence technologies or similar technologies.)
References: Dan Med J. 2023 Nov 23;70(12):. (PMID: 38018705)
Diagnostics (Basel). 2022 Jul 15;12(7):. (PMID: 35885627)
Acta Anaesthesiol Scand. 2025 Oct;69(9):e70116. (PMID: 40923322)
Eur J Trauma Emerg Surg. 2024 Jun;50(3):791-798. (PMID: 38049568)
World J Surg. 2026 Sep;50(9):2609-2624. (PMID: 42559974)
World J Emerg Surg. 2020 Apr 15;15(1):27. (PMID: 32295644)
BMJ. 2007 Oct 20;335(7624):806-8. (PMID: 17947786)
J Gastrointest Surg. 2022 May;26(5):1063-1069. (PMID: 35048258)
Ann Surg. 2024 Jan 1;279(1):88-93. (PMID: 37436871)
Eur J Trauma Emerg Surg. 2023 Jun;49(3):1355-1366. (PMID: 36708422)
World J Emerg Surg. 2024 Jun 14;19(1):24. (PMID: 38877592)
Eur J Trauma Emerg Surg. 2022 Oct;48(5):3879-3886. (PMID: 35211772)
Lancet. 2023 Oct 28;402(10412):1552-1561. (PMID: 37717589)
J Surg Res. 2018 Sep;229:234-242. (PMID: 29936996)
Scand J Surg. 2021 Dec;110(4):512-519. (PMID: 33563095)
Eur J Pediatr Surg. 2021 Aug;31(4):347-352. (PMID: 32869225)
Br J Surg. 2018 Jul;105(8):933-945. (PMID: 29902346)
J Trauma Acute Care Surg. 2018 Aug;85(2):341-347. (PMID: 29787550)
Int J Surg. 2020 Apr;76:16-24. (PMID: 32068181)
JAMA. 2026 Mar 24;335(12):1041-1049. (PMID: 41563747)
Lancet Gastroenterol Hepatol. 2025 Mar;10(3):222-233. (PMID: 39827891)
World J Surg. 2011 Jul;35(7):1626-33. (PMID: 21562871)
Surgery. 2022 Sep;172(3):798-806. (PMID: 35850731)
Contributed Indexing: Keywords: delay; postoperative complications; postoperative length of stay (LOS); time‐to‐surgery
Entry Date(s): Date Created: 20260806 Date Completed: 20260915 Latest Revision: 20260922
Update Code: 20260922
PubMed Central ID: PMC13576577
DOI: 10.1002/wjs.70506
PMID: 42559974
Βάση Δεδομένων: MEDLINE
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  Data: Associations Between Time-To-Surgery and Postoperative Length of Stay and Complications in Patients With Acute Appendicitis.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Jepsen+AH%22&quot;&gt;Jepsen AH&lt;/searchLink&gt;; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hiller&#248;d, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Ipsen+E&#216;%22&quot;&gt;Ipsen E&#216;&lt;/searchLink&gt;; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hiller&#248;d, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Finne+KF%22&quot;&gt;Finne KF&lt;/searchLink&gt;; Department of Surgery, Copenhagen University Hospital-North Zealand, Hiller&#248;d, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Knudsen+RL%22&quot;&gt;Knudsen RL&lt;/searchLink&gt;; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hiller&#248;d, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Fr&#248;lund+Bjulf+RH%22&quot;&gt;Fr&#248;lund Bjulf RH&lt;/searchLink&gt;; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hiller&#248;d, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Bahuet+AR%22&quot;&gt;Bahuet AR&lt;/searchLink&gt;; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hiller&#248;d, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Bertelsen+CA%22&quot;&gt;Bertelsen CA&lt;/searchLink&gt;; Department of Surgery, Copenhagen University Hospital-North Zealand, Hiller&#248;d, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Wiborg+Lange+KH%22&quot;&gt;Wiborg Lange KH&lt;/searchLink&gt;; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hiller&#248;d, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22H&#248;jer+Karlsen+AP%22&quot;&gt;H&#248;jer Karlsen AP&lt;/searchLink&gt;; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital-Bispebjerg, Bispebjerg, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Olsen+MH%22&quot;&gt;Olsen MH&lt;/searchLink&gt;; Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital-Bispebjerg, Bispebjerg, Denmark.; Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.; Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Kleif+J%22&quot;&gt;Kleif J&lt;/searchLink&gt;; Department of Surgery, Copenhagen University Hospital-North Zealand, Hiller&#248;d, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Lundstr&#248;m+LH%22&quot;&gt;Lundstr&#248;m LH&lt;/searchLink&gt;; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hiller&#248;d, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22N&#248;rskov+AK%22&quot;&gt;N&#248;rskov AK&lt;/searchLink&gt;; Department of Anesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hiller&#248;d, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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  Data: &lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Appendicitis%22&quot;&gt;Appendicitis*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Appendicitis+surgery%22&quot;&gt;surgery&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Length+of+Stay%22&quot;&gt;Length of Stay*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Length+of+Stay+statistics+%26+numerical+data%22&quot;&gt;statistics &amp; numerical data&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Appendectomy%22&quot;&gt;Appendectomy*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Appendectomy+methods%22&quot;&gt;methods&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Postoperative+Complications%22&quot;&gt;Postoperative Complications*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Postoperative+Complications+epidemiology%22&quot;&gt;epidemiology&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Postoperative+Complications%22&quot;&gt;Postoperative Complications*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Postoperative+Complications+etiology%22&quot;&gt;etiology&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Time-to-Treatment%22&quot;&gt;Time-to-Treatment*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Time-to-Treatment+statistics+%26+numerical+data%22&quot;&gt;statistics &amp; numerical data&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Laparoscopy%22&quot;&gt;Laparoscopy*&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Denmark%22&quot;&gt;Denmark&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Denmark+epidemiology%22&quot;&gt;epidemiology&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Humans%22&quot;&gt;Humans&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Female%22&quot;&gt;Female&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Retrospective+Studies%22&quot;&gt;Retrospective Studies&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Male%22&quot;&gt;Male&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Adult%22&quot;&gt;Adult&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Adolescent%22&quot;&gt;Adolescent&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Middle+Aged%22&quot;&gt;Middle Aged&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Young+Adult%22&quot;&gt;Young Adult&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Acute+Disease%22&quot;&gt;Acute Disease&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Time+Factors%22&quot;&gt;Time Factors&lt;/searchLink&gt;
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  Data: 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&#160;hours respectively. We hypothesized that time-to-surgery of up to 24&#160;hours after admission was not associated with increased postoperative length of stay (LOS) or complications.&lt;br /&gt;Methods: This retrospective observational cohort study included adults and adolescents (≥ 15&#160;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.&lt;br /&gt;Results: Of 25,417 laparoscopic appendectomies, 19,089 met eligibility criteria. Compared with time-to-surgery &amp;lt; 8&#160;hours, postoperative LOS was reduced when time-to-surgery was 8-16&#160;hours (mean difference -2.29&#160;hours, 95% CI: -3.85 to -0.73) and 16-24&#160;hours (-3.92&#160;hours, 95% CI: -6.05 to -1.78). Compared with time-to-surgery &amp;lt; 8&#160;hours, odds of postoperative complications were reduced for time-to-surgery up to 24&#160;hours, whereas ≥ 36&#160;hours was associated with increased odds (OR 1.57, 95% CI: 1.13 to 2.18). In complicated appendicitis, time-to-surgery 24-36&#160;hours was associated with decreased postoperative LOS (-13.0&#160;hours, 95% CI: -22 to -3.6).&lt;br /&gt;Conclusion: Time-to-surgery of up to 24&#160;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.&lt;br /&gt; (&#169; 2026 International Society of Surgery/Soci&#233;t&#233; Internationale de Chirurgie (ISS/SIC). All rights reserved, including rights for text and data mining and training of artificial intelligence technologies or similar technologies.)
– Name: Ref
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        Value: 10.1002/wjs.70506
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        StartPage: 2609
    Subjects:
      – SubjectFull: Denmark epidemiology
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Female
        Type: general
      – SubjectFull: Retrospective Studies
        Type: general
      – SubjectFull: Male
        Type: general
      – SubjectFull: Adult
        Type: general
      – SubjectFull: Adolescent
        Type: general
      – SubjectFull: Middle Aged
        Type: general
      – SubjectFull: Young Adult
        Type: general
      – SubjectFull: Acute Disease
        Type: general
      – SubjectFull: Time Factors
        Type: general
      – SubjectFull: Appendicitis surgery
        Type: general
      – SubjectFull: Length of Stay statistics & numerical data
        Type: general
      – SubjectFull: Appendectomy methods
        Type: general
      – SubjectFull: Postoperative Complications epidemiology
        Type: general
      – SubjectFull: Postoperative Complications etiology
        Type: general
      – SubjectFull: Time-to-Treatment statistics & numerical data
        Type: general
      – SubjectFull: Laparoscopy
        Type: general
    Titles:
      – TitleFull: Associations Between Time-To-Surgery and Postoperative Length of Stay and Complications in Patients With Acute Appendicitis.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Jepsen AH
      – PersonEntity:
          Name:
            NameFull: Ipsen EØ
      – PersonEntity:
          Name:
            NameFull: Finne KF
      – PersonEntity:
          Name:
            NameFull: Knudsen RL
      – PersonEntity:
          Name:
            NameFull: Frølund Bjulf RH
      – PersonEntity:
          Name:
            NameFull: Bahuet AR
      – PersonEntity:
          Name:
            NameFull: Bertelsen CA
      – PersonEntity:
          Name:
            NameFull: Wiborg Lange KH
      – PersonEntity:
          Name:
            NameFull: Højer Karlsen AP
      – PersonEntity:
          Name:
            NameFull: Olsen MH
      – PersonEntity:
          Name:
            NameFull: Kleif J
      – PersonEntity:
          Name:
            NameFull: Lundstrøm LH
      – PersonEntity:
          Name:
            NameFull: Nørskov AK
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 09
              Text: 2026 Sep
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1432-2323
          Numbering:
            – Type: volume
              Value: 50
            – Type: issue
              Value: 9
          Titles:
            – TitleFull: World journal of surgery
              Type: main
ResultId 1