43 - Freie Mitteilung
16. Mai 2019, 08:30 - 10:00, Szenario 1, 5. OG
Short term outcome after appendectomy is not related to the time of day the procedure was performed – A nationwide analysis of 9’224 patients
C. Canal1, M. Lempert2, V. Neuhaus2, M. Turina2, Presenter: C. Canal1 (1Samedan, 2Zürich)
Acute appendicitis is one of the most common indications for abdominal surgery. The risk of perforation increases if the operation is delayed. Therefore, appendicitis is considered a surgical emergency leading to appendectomies being frequently performed off-hours. Numerous studies have shown less favorable outcomes for patients treated off-hours. The purpose of this study was to determine whether the time of day an appendectomy is performed has a significant impact on mortality and complication rate of patients.
We retrospectively analyzed all appendectomies recorded in a prospective national quality measurement database (AQC-database) between 2010 and 2017. Inclusion criteria were appendicitis (ICD-K35.00 to K37), patients must have been operated, and the time of day an appendectomy was performed had to be documented. We stratified the patients in four groups depending on the start of the operation. A total of 9’224 patients with a mean age of 36 +/- 19 years (54% males) were included and further analyzed. In-hospital mortality was the primary outcome, occurrence of any complications was the secondary outcome. Variables were sought in bi- and multivariate analyses. Time of surgery was entered in multiple regression analysis models for death and complications while controlling for confounders.
Most appendectomies were performed during the afternoon and 13% in the night. The patients operated on at night had a slightly lower ASA-score, were assigned as an emergency in 98% of the cases, had fewer comorbidities and were more often publicly insured. The average duration of surgery was not significantly longer in the night group compared to the daytime groups. In-hospital mortality was 0.12% (n=11), ranging from 0.082% (n=1) in the “group night” and 0.17% (n=5) in the “group evening”. Day- or nighttime of the operation was not a predictor for mortality. The overall complication rate was 4.7%, ranging from 3.5% in the “group night” to 5.0% in the “group afternoon”. However, the differences were not significant between the different groups.
There appears to be no significant effect of the time of day an appendectomy is performed regarding mortality and complications. Due to an increasing risk of perforation when waiting for elective operating slots, nighttime operations should be preferred considering the equal perioperative risk shown in this study.