{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:11:26Z","timestamp":1792782686868,"version":"4.5.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Augsburg","id":[{"id":"https:\/\/ror.org\/03b0k9c14","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Appendectomy is one of the most frequently performed emergency surgical procedures worldwide. Current guidelines recommend surgical intervention within 24 h for uncomplicated appendicitis; however, the optimal timing for patients with complicated appendicitis remains unclear. Recent studies suggest that in-hospital delay may be safe in uncomplicated cases, yet patients with clinical or radiological signs of perforation are usually excluded. This study aims to identify clinical and laboratory risk factors for perforation and to evaluate whether it is safe to delay surgery by 6 to 9 h in patients presenting with signs of complicated appendicitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center study included patients who underwent emergency surgery for complicated appendicitis between January 2008 and June 2023. Perforation was defined histopathologically, and complications were recorded perioperatively. Multivariable logistic regression was used to identify independent risk factors for perforation and complications. Propensity-score (PS) matching was performed to control confounding factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1,027 patients with suspected complicated appendicitis were included. PS matching yielded two cohorts of 327 patients. No significant differences were observed in perforation rates (46.5% vs. 47.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.88) or complication rates (23.5% vs. 21.4%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.51). Logistic regression analysis of the PS matched groups confirmed that a delay of surgery of &gt;\u20096\u00a0h was not associated with increased risk of perforation (OR 1.03; 95% CI 0.75\u20131.41;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.87) or complication rate (OR 0.87; 95% CI 0.59\u20131.27;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.47). A 9-hour threshold to surgery showed no significant differences in perforation rates (50.0% vs. 44.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.34) or complication rates (24.7% vs. 19.7%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.25). Logistic regression analysis did not demonstrate an association between a surgical delay of &gt;\u20099\u00a0h and either perforation (OR 0.79; 95% CI: 0.51\u20131.22;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.28) or complication rate (OR 0.68; 95% CI: 0.39\u20131.17;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.16).\n                    <\/jats:p>\n                    <jats:p>Age\u2009&gt;\u200965 years, higher BMI, symptom duration\u2009&gt;\u200948 h at the time of admission, elevated inflammatory markers, and suspected perforation on imaging were identified as independent risk factors for perforation. Higher ASA scores, male sex, suspected perforation on imaging, and elevated CRP levels were associated with increased complication rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>A delay in surgical intervention of 6\u20139\u00a0h may be acceptable in patients with suspected complicated appendicitis without increasing the risk of perforation and \/ or complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00423-026-04264-3","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T08:44:20Z","timestamp":1792745060000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety of in-hospital delay of appendectomy in complicated appendicitis \u2013 a propensity score\u2013matched analysis of 1027 patients"],"prefix":"10.1007","volume":"411","author":[{"given":"Lena","family":"Anthuber","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Schiele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gernot","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Mair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Sommer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Pinto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Anthuber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Beyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Schrempf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"issue":"10000","key":"4264_CR1","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1016\/S0140-6736(15)00275-5","volume":"386","author":"A Bhangu","year":"2015","unstructured":"Bhangu A et al (2015) Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. 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The study protocol was submitted to and approved by the Ethics Committee of Ludwig-Maximilians-Universit\u00e4t (LMU) Munich (reference number 23\u20130500). Informed patient consent was not required due to the retrospective nature of the study. All procedures were conducted in accordance with the principles outlined in the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. All data is anonymized. No personal information is shared in the manuscript.","order":2,"name":"Ethics","label":"Consent to publish","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"288"}}