EVALUATING THE SAFETY AND EFFICACY OF EARLY VERSUS DELAYED APPENDECTOMY IN COMPLICATED APPENDICITIS

Abstract

Background: The optimal timing of surgery for complicated appendicitis remains debated, with early and delayed (interval) appendectomy both being practiced.

Objective: This study aimed to compare the safety and efficacy of early versus delayed appendectomy in patients with complicated appendicitis.

Methodology: This prospective comparative study was conducted at Shaikh Zayed Hospital, Lahore from December 2024 to May 2025. A total of 185 patients aged ≥12 years with perforated, gangrenous appendicitis or cases with abscess/phlegmon were enrolled using non-probability consecutive sampling. Patients were allocated to Group A (early appendectomy within 24 hours of diagnosis) or Group B (delayed appendectomy after initial non-operative management and elective surgery at 6–8 weeks).

Results: Of 185 patients, 94 underwent early appendectomy and 91 underwent delayed appendectomy. Baseline demographics and disease severity were comparable between groups (p > 0.05). Early appendectomy was associated with significantly shorter operative time (67.5 ± 10.8 vs. 74.9 ± 12.3 minutes; p < 0.001), less blood loss (84.6 ± 18.2 vs. 96.2 ± 21.1 mL; p < 0.001), shorter hospital stays (5.8 ± 1.4 vs. 9.7 ± 2.3 days; p < 0.001), and faster return to normal activities (11.3 ± 3.2 vs. 17.5 ± 4.1 days; p < 0.001). Wound infection rates were lower in early appendectomy (8.5% vs. 15.4%; p = 0.04), while other complications, including intra-abdominal abscess and ileus, were not significantly different.

Conclusion: Early appendectomy offers distinct clinical benefits over delayed appendectomy in complicated appendicitis, including faster recovery, reduced hospital stays, and lower wound infection rates, without increasing major complications. Where feasible, early surgical intervention should be considered the preferred approach.