(D)Elayed vs. (E)Arly (L)Aparoscopic (A)Ppendectom(Y)
(D)Elayed vs. (E)Arly (L)Aparoscopic (A)Ppendectom(Y)
The DELAY Trial will compare immediate (< 6 hours from decision to operate) to delayed
 (Surgery to take place the following morning) appendectomy in adult patients presenting to
 the emergency department with suspected acute appendicitis. The primary outcome will be 30
 day postoperative complications.
This randomized controlled trial is designed to assess the effect of timing of surgery on
 surgical complications in patients undergoing appendectomy for acute appendicitis at one of
 two participating institutions.

 Early appendectomy in patients diagnosed with acute appendicitis has been a mainstay of
 treatment. Timely intervention is recommended to avoid the risks associated with perforated
 appendicitis, which has been shown to increase the risk of post-operative complications
 compared to non-perforated appendicitis. However, some studies have suggested that delaying
 appendectomy does not increase complications. Several studies have also assessed the safety
 of nighttime operating with conflicting results. Some suggest that delaying surgery until
 daytime is safe.

 This study is a prospective, randomized controlled trial with blinding of the outcome
 assessors. Eligible participants will be adult patients diagnosed with acute appendicitis
 with an expected operative start time between 2000-0400. Patients randomized to the
 intervention group will have delayed surgery after 0530 the following morning to avoid
 nighttime operating. Patients randomized to the control group will receive immediate surgery
 within 6 hours of the decision to operate. The follow up period will be a minimum of 30 days.
 Independent outcome assessors will assess patients during their postoperative course in
 hospital as well as in the outpatient follow up clinic.

 The primary outcome for this study is complication occurring within 30 days of surgery.
 Complication includes any of the following: mortality, readmission to hospital, emergency
 department (ED) visit, percutaneous drain insertion, reoperation, prolonged hospital stay
 greater than 7 days, and a predefined list of postoperative complications. Secondary outcomes
 include perforated appendicitis, operative time, and length of stay.
Inclusion Criteria:

 -  Adult patients ≥ 18 years of age

 -  Imaging confirmed diagnosis of appendicitis (ultrasound or CT or MRI)

 -  Expected time of operation between 2200 - 0400 and occurs within 6 hours of the
 decision to operate

 Exclusion Criteria:

 -  Patients with hemodynamic instability

 -  Patients with suspected sepsis

 -  Unknown diagnosis

 -  Presence of abscess on CT Scan

 -  Diagnosis of missed appendicitis

 -  Pregnancy

 -  Patients who are not surgical candidates

 -  Patients who are not competent to sign consent