Cameron DB, et al. - The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee conducted this systematic review to develop recommendations regarding time to appendectomy for acute appendicitis in children within the context of preventing adverse events, reducing cost, and optimizing patient/parent satisfaction. High-quality evidence was scarce in the literature regarding timing of appendectomy for patients with acute appendicitis and its association with adverse events or resource utilization. Available evidence suggested no association of appendectomy performed within the first 24 h from presentation with an increased risk of perforation or adverse outcomes.

Methods

• Three questions were selected by the committee that were addressed by searching MEDLINE, Embase, and the Cochrane Library databases for English language articles published between January 1, 1970 and November 3, 2016.
• For each question, consensus recommendations were made for both children and adults; these recommendations were based on the best available evidence.

Results

• Based on level 3–4 evidence, increased perforation rates or other adverse events were not observed in association with appendectomy performed within 24 h of admission in patients with acute appendicitis.
• Based on level 4 evidence, time from admission to appendectomy within 24 h seemed not to increase hospital cost or length of stay (LOS).