In patients with perforated appendicitis, delaying appendectomy leads to significantly worse clinical outcomes compared to performing it at the time of admission.

• Elective interval appendectomy is associated with a nearly doubled risk of ileocecal resection compared to early appendectomy (adjusted OR 1.92).
• Both elective and failed interval appendectomies increase the risk of infectious complications (adjusted ORs 3.14 and 2.09, respectively) and nonroutine discharge (adjusted ORs 1.49 and 1.69).

Surgeons should favor early appendectomy in perforated cases to minimize complications and improve patient disposition.