Delayed Appendectomy Versus Early Intervention: A Systematic Review of Outcomes in Complicated Appendicitis

The management of complicated appendicitis remains a subject of debate, particularly concerning the optimal timing of surgical intervention. While early appendectomy has been the traditional approach, there is growing clinical interest in delayed surgery with initial antibiotic therapy. The existing evidence, however, presents conflicting outcomes, creating uncertainty for surgeons. Therefore, the rationale for this study is to synthesize the available evidence to provide a clearer understanding of the comparative outcomes of early versus delayed surgical strategies. This systematic review aims to evaluate the outcomes of delayed versus early surgical intervention in patients with complicated appendicitis. A comprehensive search of four databases yielded 452 relevant publications. After duplicate removal using Rayyan QCRI, 162 records were screened for relevance, and 29 full-text articles were assessed for eligibility. Ultimately, three studies met the inclusion criteria for evidence synthesis. The total pooled population was 41,274 patients (Early Surgery [ES] Group: 35,923; Delayed Surgery [LS] Group: 5,351), of whom 22,789 (55.2%) were male. The analysis revealed a nuanced tradeoff between the two approaches. Early surgery was consistently associated with a shorter overall hospital stay and lower medical costs. However, it was linked to a higher incidence of wound infections. Conversely, delayed surgery was associated with a significantly lower rate of major surgical procedures, such as ileocecectomy or right hemicolectomy, and fewer overall complications, despite sometimes resulting in a longer hospitalization. These findings highlight the complexity of decision-making in complicated appendicitis. The choice between early and delayed intervention involves balancing the risks of infection against the need for more extensive surgery. This contradiction in the literature underscores the necessity for further rigorous, prospective studies to definitively establish optimal timing and develop tailored treatment strategies that improve patient outcomes.