Impact of preoperative delay on perforation in pediatric appendicitis

To investigate the impact of preoperative delay (<8 h vs. <24 h) on appendiceal perforation in children with uncomplicated acute appendicitis (UAA) undergoing laparoscopic appendectomy, and to assess the risk associated with appendiceal fecalith.

A retrospective study included children with UAA who underwent laparoscopic appendectomy from January 2025 to December 2025. Based on preoperative waiting time, children were divided into control group (<8 h, n = 122) and observation group (<24 h, n = 75). Primary outcome was intraoperative perforation rate (AAST grade 3-5). Secondary outcomes included operation time, hospital stay, pathological results, complications, and costs.

Baseline data were comparable between groups (P > 0.05). The AAST perforation rate was 7.38% (9/122) in the control group and 9.33% (7/75) in the observation group (P > 0.05). No significant differences were found in operation time, hospital stay, complications, or costs (P > 0.05). In the fecalith subgroup, no significant difference in AAST perforation rates was observed (P > 0.05), but significant differences were found in operation time [38.7 vs. 41.0 min, P = 0.045], pathological perforation rate (12.16% vs. 28.21%, P = 0.034), and preoperative delay time (6.21 ± 2.00 vs. 13.89 ± 2.23 h, P < 0.001). Appendiceal fecalith was identified as a risk factor for perforation in delayed surgery. No serious complications occurred during 30-day follow-up.

Delaying laparoscopic appendectomy to within 24 h for children with UAA does not significantly increase the risk of intraoperative perforation compared to surgery within 8 h. Such surgeries can be safely scheduled for the next morning to optimize night shift resource allocation. However, children with preoperative evidence of appendiceal fecalith are at higher risk of perforation and should receive timely surgical intervention.