Fulltext

Introduction of a New Policy of no Nighttime Appendectomies: Impact on Appendiceal Perforation Rates and Postoperative Morbidity

Schnüriger, Beat ; Laue, Jessica ; Kröll, Dino ; Inderbitzin, Daniel ; Seiler, Christian ; Candinas, Daniel

In: World Journal of Surgery, 2014, vol. 38, no. 1, p. 18-24

Ajouter à la liste personnelle
    Titre
    • Introduction of a New Policy of no Nighttime Appendectomies: Impact on Appendiceal Perforation Rates and Postoperative Morbidity
    Auteur
    • Schnüriger, Beat. Department of Visceral Surgery and Medicine, Bern University Hospital, 3010, Bern, Switzerland
    • Laue, Jessica. Department of Visceral Surgery and Medicine, Bern University Hospital, 3010, Bern, Switzerland
    • Kröll, Dino. Department of Visceral Surgery and Medicine, Bern University Hospital, 3010, Bern, Switzerland
    • Inderbitzin, Daniel. Department of Visceral Surgery and Medicine, Bern University Hospital, 3010, Bern, Switzerland
    • Seiler, Christian. Department of Visceral Surgery and Medicine, Bern University Hospital, 3010, Bern, Switzerland
    • Candinas, Daniel. Department of Visceral Surgery and Medicine, Bern University Hospital, 3010, Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • World Journal of Surgery, 2014, vol. 38, no. 1, p. 18-24. Springer US; http://www.springer-ny.com
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:326198
    Summary
    Background: Working hour limitations and tight health care budgets have posed significant challenges to emergency surgical services. Since 1 January 2010, surgical interventions at Berne University Hospital between 23:00 and 08:00h have been restricted to patients with an expected serious adverse outcome if not operated on within 6h. This study was designed to assess the safety of this new policy that restricts nighttime appendectomies (AEs). Methods: The patients that underwent AE from 1 January 2010 to 31 December 2011 ("2010-2011 group”) were compared retrospectively with patients that underwent AE before introduction of the new policy (1 January 2006-31 December 2009; "2006-2009 group”). Results: Overall, 390 patients were analyzed. There were 255 patients in the 2006-2009 group and 135 patients in the 2010-2011 group. Patients' demographics did not differ statistically between the two study groups; however, 45.9% of the 2006-2009 group and 18.5% of the 2010-2011 group were operated between 23:00 and 08:00h (p<0.001). The rates of appendiceal perforations and surgical site infections did not differ statistically between the 2006-2009 group and the 2010-2011 group (20 vs. 18.5%, p=0.725 and 2 vs. 0%, p=0.102). Additionally, no difference was found for the hospital length of stay (3.9±7.4 vs. 3.4±6.0days, p=0.586). However, the proportion of patients with an in-hospital delay of>12h was significantly greater in the 2010-2011 group than in the 2006-2009 group [55.6 vs. 43.5%, p=0.024, odds ratio (95% confidence interval 1.62 (1.1-2.47)]. Conclusions: Restricting AEs from 23:00 to 08:00h does not increase the perforation rates and occurrence of clinical outcomes. Therefore, these results suggest that appendicitis may be managed safely in a semielective manner.