Avoidable complications in appendectomy: Where the most frequent errors occur

Acute appendicitis represents the most frequent abdominal surgical emergency worldwide, yet it remains associated with significant preventable morbidity often masked by its routine nature. This review dissects the trajectory of care to identify specific, avoidable errors in diagnostic and surgical management. A comprehensive narrative review was conducted utilizing PubMed, Embase, and Cochrane Library databases to analyze high-level evidence and international guidelines published between 2000 and 2025. The results indicate that diagnostic delays in elderly and pediatric populations are the primary drivers of perforation, while inconsistent use of computed tomography contributes to unnecessary negative appendectomies. Technical failures, including improper stump closure and thermal bowel injuries, alongside outdated practices like peritoneal lavage and prolonged antibiotic courses, significantly increase complication rates. Furthermore, cognitive biases such as premature closure and plan continuation bias profoundly impact clinical judgment during critical decision-making nodes. Consequently, reducing morbidity requires a paradigm shift from complacency to high-reliability performance. This demands strict adherence to evidence-based protocols, including standardized imaging for high-risk groups, rigorous antibiotic stewardship, and the implementation of specific safety checklists to mitigate systemic errors and improve patient safety outcomes.