Early versus delayed appendectomy for acute uncomplicated appendicitis in adult and pediatric patients: A systematic review and meta-analysis

BACKGROUND: Appendicitis has traditionally been managed with urgent surgery. Because of operative room and logistic constraints, surgery may be delayed. Evidence on the impact of this delay remains equivocal. The aim of this systematic review and meta-analysis is to assess postoperative outcomes of delayed appendectomy amongst both pediatric and adult populations. METHODS: A systematic review with meta-analysis was performed including studies comparing cohorts of urgent versus delayed appendectomy, excluding those with interval appendectomy. Studies were included as long as one relevant postoperative complication was mentioned; for adults, only prospective studies were included. A comprehensive search of six databases was performed including studies from January 1, 2000, to January 15, 2024. A meta-analysis with a random effects model and restricted maximum likelihood was used. RESULTS: Of 11,227 citations, 20 pediatric and 5 adult studies were included, with 827,019 and 4250 patients, respectively. Definitions of early surgery cohorts were usually surgery within 4 to 12 hours or overnight, and delayed surgery >4 to 12 hours or next day. The pediatric meta-analysis revealed no increased risk of intraoperative perforation in delayed versus emergent cohorts (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.78-1.72), length of stay (mean difference, 1.2 days; 95% CI, -0.3 to -2.8), abscess (OR, 0.80; 95% CI, 0.29-2.25), surgical site infection (OR, 1.11; 95% CI, 0.93-1.30), or readmission (OR, 0.82; 95% CI, 0.55-1.21). The adult meta-analysis results revealed no difference between the delayed and emergent appendectomy groups for intraoperative perforation (OR, 1.29; 95% CI, 1.00-1.67), abscess (OR, 1.54; 95% CI, 0.58-4.10), surgical site infection (OR, 1.35; 95% CI, 0.71-2.56), or conversion to open (OR, 0.81; 95% CI, 0.64-1.03). Subgroup analyses showed increased length of stay in pediatric population (mean difference, 0.42 days; 95% CI, 0.10-0.74). CONCLUSION: These findings suggest that a modest delay in appendectomy may be permissible in pediatric and adult settings and adult patients presenting with acute appendicitis. While this does not replace surgeon clinical acumen, it may help guide decision making in resource-constrained settings. ( J Trauma Acute Care Surg . 2026;100: 822-830. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Systematic Review and Meta-analysis; Level III.