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A new global study into appendicitis has found major inequalities in care, with some countries having little access to CT imaging or minimally invasive surgery—resulting in poorer patient outcomes.

Published in the Lancet Global Health, the Appendicitis Global Outcomes Study (AlliGatOr) found that delays in accessing surgical assessment for suspected appendicitis are associated with a significantly higher risk of life-threatening complications.

Led by University of Birmingham researchers, the international study analyzed data from more than 45,000 patients across 112 countries—providing new insights into when delays matter most in this common emergency condition.

The study—which is the largest prospective global study of appendicitis ever conducted—found that the longer patients waited before being assessed by a surgeon, the higher their risk of perforation. Rates rose progressively from around 23% in patients assessed within 12 hours to 48% in those waiting more than 72 hours.

Appendicitis is the most common abdominal surgical emergency worldwide. If left untreated, it can lead to perforation (a burst appendix), which is associated with an increased risk of complications such as longer hospital stays or infections.

Dr. Dmitri Nepogodiev, from the University of Birmingham and senior lead author of the study, said, "Appendicitis surgery is a key focus for global surgical improvements, as it is one of the most common emergency surgeries and has significant consequences for patients. We are very grateful for the many thousands of patients who consented to take part in the largest study of its kind.

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