Nighttime Appendectomy is Safe and has Similar Outcomes as Daytime Appendectomy: A Study of 1198 Appendectomies

Abstract

Introduction: Although it is controversial whether appendectomy can be safely delayed, it is often unnecessary to postpone operation as a shorter delay may increase patient comfort, enables quicker recovery, and decreases costs. In this study, we sought to study whether the time of day influences the outcomes among patients operated on for acute appendicitis. Materials and Methods: Consecutive patients undergoing appendectomy at Tampere University Hospital between 1 September 2014 and 30 April 2017 for acute appendicitis were included. Primary outcome measures were postoperative morbidity, mortality, length of hospital stay, and amount of intraoperative bleeding. Appendectomies were divided into daytime and nighttime operations. Results: A total of 1198 patients underwent appendectomy, of which 65% were operated during daytime and 35% during nighttime. Patient and disease-related characteristics were similar in both groups. The overall morbidity and mortality rates were 4.8% and 0.2%, respectively. No time categories were associated with risk of complications or complication severity. Neither was there difference in operation time and clinically significant difference in intraoperative bleeding. Patients undergoing surgery during night hours had a shorter hospital stay. In multivariate analysis, only complicated appendicitis was associated with worse outcomes. Discussion: We have shown that nighttime appendectomy is associated with similar outcomes than daytime appendectomy. Subsequently, appendectomy should be planned for the next available slot, minimizing delay whenever possible.

Clinical Outcomes of Daytime Versus Nighttime Laparoscopic Appendectomy in Children

“…In terms of complication rates, this study confirmed the safety of nighttime appendectomy, with no significant differences between study groups. Similar to previous publications, the most common complication in both study groups was abscess formation [ 3 , 24 , 35 ]. Other postoperative complications such as ileus, wound infections, and bleeding at the trocar insertion site were less common.…”

“…A recent meta-analysis clearly demonstrated that delayed laparoscopic appendectomy (up to 24 h) does not increase the likelihood of developing complications in simple appendicitis [ 23 ]. In addition, previously published results suggest that surgeons may defer appendectomy in patients with suspected simple appendicitis occurring at night [ 23 , 24 ]. Another recent study has shown that short deferral of appendectomy does not increase the risk of appendiceal perforation, but may be associated with a slightly increased risk of surgical site infections [ 25 , 26 ].…”

Daytime versus nighttime laparoscopic appendectomy in term of complications and clinical outcomes: A retrospective study of 1001 appendectomies

“…Additionally, Monttinen et al. [ 29 ] in another study found that out of 1,198 patients, there was a 4.8 percent complication rate and a 0.2 percent death rate. This study also had a relatively large sample size of 1001 patients.…”

“…A study by Monttinen et al. showed that operations performed at night had a lower length of hospital stay [ 29 ]. Despite the increase in workload and sleepiness during the night shifts, a study by Tomasko and co-workers found that clinicians were able to perform surgeries proficiently and the rest of the staff were getting their tasks done correctly, and it also believes that operating at nighttime and having sleep deprivation does not decrease cognitive function but instead increases it [ 35 , 36 ].…”

Routine use of laparoscopic techniques in daily practice improves outcomes after appendectomy

“…Usually in mild cases patients can safely wait until the next morning. However, earlier surgery and symptom relief reduces length of hospital stay, improves patient satisfaction and also achieves cost-savings [14,15]. We demonstrated that complicated procedures are associated with higher rate of postoperative infections.…”