Objectives: Despite much progress in surgery, controversy still exists as regard the timing of appendectomy. This study aims at determining the relationship between pathological severity, complications, hospital stay and timing of appendectomy. Patients and methods: All patients diagnosed as acute appendicitis at Surgery Department in Minia University Hospital over the year 2018 were included. Patients<18 years, patients not recognizing the exact time of symptom onset and patients with negative appendicitis in pathology examination were excluded. The diagnosis was confirmed by ultrasound or CT prior to surgery. Pre-hospital, in-hospital and whole elapsed times were recorded. Macroscopic appearance and stage was described at surgery. Postoperative complications and hospital stay were recorded. Results: The number of included patients was 182; 119 males and 63 females. The mean age was 30.5 ± 6.19 years. Advanced age was significantly associated with advanced pathology (p<0.001). The mean temperature was 37.8 ± 0.75°C with significant associated between high temperature and advanced pathology (p<0.001). Mean WBC count was 12,380 ± 0.98 cells/µL with significant correlation between leukocytosis and advanced pathology (p<0.001). Advanced pathology was significantly correlated to pre-hospital elapsed time (Range 31.26 ± 3.74 to 52.30 ± 2.92 h) and to whole elapsed time (Range 43.43 ± 3.75 to 66.62 ± 2.82 h). Hospital stay (1.66 ± 0.30 days for stage 1 up to 7.50 ± 0.51 days for stage 4) and complication rate (4% for stage 1 up to 100% for stage 4) significantly correlated to advanced pathology (p<0.001). Conclusion: Early appendectomy may stop the pathological progress with subsequent reduction in complication rate and hospital stay. So, early appendectomy is recommended.