Sex-Based Disparities in Acute Appendicitis: A Nationwide Analysis

Acute appendicitis demonstrates significant sex-based variations in incidence, presentation, and outcomes, yet such disparities have not been well studied. This study aimed to investigate sex-based differences in time to appendectomy in patients with acute appendicitis.

The 2013-2017 American College of Surgeons National Surgical Quality Improvement Program database was used to identify all patients ≥18 y with acute appendicitis undergoing emergency appendectomy. Delayed appendectomy was defined as that performed >12 h following admission. Multivariable logistic regression adjusting for demographics, comorbidities, disease severity, and surgical approach was used to examine the association between sex and delayed appendectomy. We further evaluated the association between delayed appendectomy and secondary outcomes, including mortality and postoperative complications.

117,682 patients were included: 57,067 (48.5%) males and 60,615 (51.5%) females. The mean time to appendectomy was 5.7 ± 10.7 h in females compared to 5.0 ± 10.1 h in males (P < 0.001). On multivariable analyses, female patients were more likely to experience delayed appendectomy (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 1.12-1.20) and postoperative bleeding requiring transfusion (aOR 1.76, 95% CI 1.37-2.24) compared to males. In addition, delayed appendectomy was associated with a higher risk of unplanned reoperation (aOR 1.16, 95% CI 1.01-1.35), 30-day readmission (aOR 1.09, 95% CI 1.01-1.19), and prolonged hospital stay (aOR 5.76, 95% CI 5.51-6.03).

Female patients with acute appendicitis are more likely to experience delayed appendectomy. These findings highlight the need for further studies to address sex-based disparities in the management of acute appendicitis.