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PURPOSE: Appendicitis is one of the most common emergency diseases. Currently, it is unclear whether there are differences in performing appendectomy during in-hour (IH) versus out-of-hour (OH). METHODS: A comprehensive search for studies that compared IH and OH was conducted in Web of Science, PubMed and EMBASE. Data of including studies were subjected to meta-analysis. The study was registered on PROSPERO (CRD42023467592). RESULT: The result indicated that the OH group had more complicated appendicitis (OH 25.1% vs. IH 24.5%, RD = 0.02; 95% CI, 0.00 to 0.05; p = 0.04, I2 = 72%), higher level of C-reactive reaction protein (OH 44.88 ± 16.14 vs. IH 41.19 ± 16.50, MD = 12.15; 95% CI, 2.28 to 22.01; p = 0.02, I2 = 100%) and higher rate of conversion to open surgery {OH 8.0% vs. IH 7.8%, RD = 0.02; 95% CI, 0.00 to 0.03; p = 0.02, I2 = 93%. 95% Predictive interval (PI), -0.04 to 0.08}. No significant differences were observed in operative time, length of hospital stay, surgical site infection rates, readmission, reintervention, or the distribution of Clavien-Dindo grades1-2 and3-4 complications. Thirty-day mortality and overall mortality were also comparable. CONCLUSION: OH appendectomy does not affect perioperative complications or mortality in patients with appendicitis compared to IH. These results should be interpreted cautiously due to the limited number of available studies.