Timing of laparoscopic appendectomy and impacts on outcomes: A retrospective study of patients across in-hours, after-hours and holidays

doi:10.4240/wjgs.v18.i1.114336

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Jan 27, 2026; 18(1): 114336
Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.114336

Timing of laparoscopic appendectomy and impacts on outcomes: A retrospective study of patients across in-hours, after-hours and holidays

Murat Demir, Baki Ekci, Sadik Peker, Ali Bekraki, Ali Levent Isik, Huseyin Kilavuz, Idris Kurtulus

Murat Demir, Baki Ekci, Sadik Peker, Ali Bekraki, Ali Levent Isik, Huseyin Kilavuz, Idris Kurtulus, Department of General Surgery, Basaksehir Cam and Sakura City Hospital, Basaksehir 34480, Istanbul, Türkiye

Co-corresponding authors: Murat Demir and Huseyin Kilavuz.

Author contributions: Demir M, Ekci B and Kurtulus I conceptualized the study; Demir M, Kilavuz H and Kurtulus I developed the methodology; Demir M, Peker S and Isik AL were responsible for software; Demir M, Kilavuz H, Peker S and Bekraki A performed validation; Demir M, Ekci B and Bekraki A conducted formal analysis; Ekci B, Isik AL and Bekraki A provided resources; Demir M, Isik AL and Peker S curated the data; Demir M prepared the original draft; Ekci B, Kilavuz H and Kurtulus I reviewed and edited the manuscript; Ekci B handled visualization; Ekci B and Kurtulus I supervised and administered the project. All authors have read and agreed to the published version of the manuscript. Demir M and Kilavuz H contributed equally to this article, they are the co-corresponding authors of this manuscript. Demir M and Kilavuz H were both deeply involved in the study’s development, coordination, and refinement from its initial conception through the final submission. Kilavuz H also played an important role in guiding the communication process with the journal and provided valuable support based on his previous experience as a reviewer. Given their equal intellectual input and complementary responsibilities, assigning both individuals as co-corresponding authors ensures a fair and transparent acknowledgment of their contributions and reflects the collaborative character of the research.

Institutional review board statement: This study was approved by the Ethics Committee of Cam and Sakura City Hospital (Approval Code: 2025/151, Approval Date: 07 May 2025).

Informed consent statement: All patients were informed about the surgical procedures before surgery and signed an informed consent form.

Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: Participants gave informed consent for data sharing, and the presented data are fully anonymized. Technical appendix, statistical code, and dataset are available from the corresponding author at [muratdemir57@gmail.com].

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Murat Demir, MD, Consultant, Department of General Surgery, Basaksehir Cam and Sakura City Hospital, G-434 Street No. 2L, Basaksehir 34480, Istanbul, Türkiye. muratdemir57@gmail.com

Received: September 17, 2025
Revised: October 27, 2025
Accepted: November 20, 2025
Published online: January 27, 2026
Processing time: 126 Days and 22.9 Hours

Abstract

BACKGROUND

Acute appendicitis is a common surgical emergency, and appendectomy is essential to prevent complications such as perforation and peritonitis. Although the procedure is routine, outcomes may be affected by surgery timing, staffing, and hospital resources. Evidence on whether off-hour operations increase complications is conflicting. This study aimed to assess whether laparoscopic appendectomy performed during weekday in-hours, after-hours, or holiday periods influences postoperative outcomes.

AIM

To investigate clinical outcomes of laparoscopic appendectomy performed during weekday daytime, weekday evening, and weekends or holidays.

METHODS

The data of 977 patients who underwent laparoscopic appendectomy in a high-volume tertiary hospital between January 1, 2024, and December 31, 2024, were recruited. Patients were divided into three groups including surgeries during regular weekday in-hours (group 1), during weekday after-hours (group 2) and during weekends or extended holiday periods (group 3). Demographic, peri-, and postoperative data were compared.

RESULTS

There were no significant differences in operative time, conversion to open surgery, or complication rates between all groups. However, patients in the weekend/holiday group had significantly shorter time to surgery (median: 584 minutes vs 589 minutes vs 535 minutes, P = 0.002), and patients in the weekday in-hours group had significantly longer hospital stays than the other groups (median: 2 days vs 1 day vs 1 day, P < 0.001). No mortality occurred in any group.

CONCLUSION

In a well-staffed center, laparoscopic appendectomy during weekends or holidays is safe and may offer faster surgical access. Delay to surgery, not the working hour, is the main factor affecting outcomes.

Keywords: Laparoscopic appendectomy; Surgery timing; Weekend effect; Hospital stay; Surgical delay

Core Tip: The timing of laparoscopic appendectomy-whether during in-hours, after-hours, or weekends-does not negatively influence outcomes in well-organized tertiary centers. When performed in adequately staffed settings, weekend or holiday procedures are safe and may even allow faster surgical access. The principal factor affecting patient outcomes is surgical delay rather than the specific working hour.