{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T07:25:41Z","timestamp":1786951541937,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Elderly patients with acute appendicitis face high rates of complicated disease, yet the impact of in\u2010hospital timing and the utility of simple biomarkers remain debated. We aimed to assess whether in\u2010hospital timing influences severity and to evaluate the derived neutrophil\u2010to\u2010lymphocyte ratio (dNLR) as a risk\u2010stratification tool.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective study of 412 patients (184 aged \u2265 65\u00a0years; 228 younger controls) undergoing appendectomy (2010\u20132019) was conducted. We analyzed Patient Interval (symptom onset to admission) and Hospital Interval (admission to incision). Appendicitis was graded as uncomplicated or complicated (gangrenous\/perforated). Multivariable regression and categorical sensitivity analyses (0\u20136, 6\u201312, 12\u201318, >\u00a018\u00a0h) were used to identify predictors of severity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Elderly patients had higher rates of complicated appendicitis (29.4% vs. 9.2%) and morbidity (13.0% vs. 1.3%). While night\u2010shift admission increased time to diagnosis, it did not increase complications. Hospital Interval was shorter in the elderly (13.5 vs. 15.4\u00a0h) but was not an independent predictor of complications and showed no adverse trend across time categories. In the elderly, dNLR \u2265 4.0 independently predicted complicated disease (AUC 0.65) alongside age, fever, and Patient Interval. Mortality spiked to 8.3% in patients \u2265 85\u00a0years, driven by medical complications.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Disease severity in geriatric appendicitis appears to be largely determined prior to admission. Within the limitations of this observational design, short in\u2010hospital delays for optimization or logistical reasons were not associated with increased perforation or morbidity. Furthermore, a dNLR \u2265\u00a04.0 helps identify high\u2010risk patients, suggesting that an \u201coptimize then operate\u201d approach\u2014prioritizing physiological stabilization may be a safe and reasonable strategy for clinically stable elderly patients.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n Research Registry (UIN: researchregistry11765)<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/wjs.70447","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:23:11Z","timestamp":1782919391000},"page":"2306-2312","source":"Crossref","is-referenced-by-count":0,"title":["The Safety of In\u2010Hospital Delay and the Utility of dNLR in Elderly Patients With Acute Appendicitis"],"prefix":"10.1002","volume":"50","author":[{"given":"Offir","family":"Ben\u2010Ishay","sequence":"first","affiliation":[{"name":"Department of General Surgery Rambam Health Care Campus and Ruth and Bruce Rappaport Faculty of Medicine Technion Institute of Technology Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noa","family":"Carmon","sequence":"additional","affiliation":[{"name":"Department of General Surgery Rambam Health Care Campus and Ruth and Bruce Rappaport Faculty of Medicine Technion Institute of Technology Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roi","family":"Abramov","sequence":"additional","affiliation":[{"name":"Department of General Surgery Rambam Health Care Campus and Ruth and Bruce Rappaport Faculty of Medicine Technion Institute of Technology Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayim","family":"Gilshtein","sequence":"additional","affiliation":[{"name":"Department of General Surgery Rambam Health Care Campus and Ruth and Bruce Rappaport Faculty of Medicine Technion Institute of Technology Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","first-page":"56","article-title":"The Global, Regional, and National Burden of Appendicitis in the Elderly Population Aged 60 Years and Above From 1990 to 2021","volume":"23","author":"Guan X.","year":"2023","journal-title":"BMC Public Health"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010020\u201000306\u20103"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(23)01311\u20109"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24076466"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13104\u2010016\u20102335\u20105"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.70006"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/js9.0000000000001268"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/sle.0000000000000952"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000231726.53487.dd"},{"issue":"4","key":"e_1_2_12_11_1","first-page":"582","article-title":"Timing of Appendectomy for Acute Appendicitis: A Systematic Review and Network Meta\u2010Analysis","volume":"279","author":"Byrne 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Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70447","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70447","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70447","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T06:58:42Z","timestamp":1786949922000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70447"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":15,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/wjs.70447"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70447","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]}}}