Impact of in-hospital delay on clinical and economic outcomes after laparoscopic appendectomy for acute appendicitis: a single-center retrospective cohort study

Abstract

Purpose Optimal timing of appendectomy after hospital arrival remains controversial. Although early surgery has traditionally been recommended, recent evidence suggests short in-hospital delays may not adversely affect outcomes. This study evaluated the impact of hospital arrival-to-operation time on postoperative outcomes and hospital costs in patients undergoing laparoscopic appendectomy. Methods We conducted a retrospective study of 661 patients who underwent laparoscopic appendectomy. Patients were categorized into 3 groups according to the interval between hospital arrival and operation start: ≤6 hours (group 1), >6 to ≤12 hours (group 2), and >12 hours (group 3). Baseline characteristics, operative outcomes, postoperative complications, recovery parameters, and hospital costs were compared. Multivariable logistic regression was performed to assess the independent association between in-hospital delay and postoperative complications. Results Baseline demographic and clinical characteristics were comparable among groups, although American Society of Anesthesiologists classification and serum albumin levels differed slightly. The overall 30-day postoperative complication rates were similar (8.5%, 9.5%, and 10.0% in groups 1, 2, and 3, respectively; P = 0.848). Multivariable analysis showed that in-hospital delay was not independently associated with postoperative complications. No significant differences were observed in severe complications, readmission, mortality, time to oral water intake, soft diet initiation, length of hospital stay, or hospital costs (P = 0.529). Conclusion An in-hospital delay of >12 hours before appendectomy was not associated with increased postoperative complications, prolonged hospitalization, or higher hospital costs. These findings support flexible scheduling of laparoscopic appendectomy while maintaining safe clinical outcomes.