Crandall Marie, Shapiro Michael B, Worley Marci, West Michael A
Division of Trauma & Surgical Critical Care, Department of Surgery, Northwestern University, Chicago, Illinois 60611, USA.
Surg Infect (Larchmt). 2009 Feb;10(1):65-9. doi: 10.1089/sur.2008.0004.
Acute appendicitis is the most common surgical infection requiring operative intervention, and length of stay (LOS) typically is short. The timing of emergency appendectomies for acute appendicitis depends on many factors, including anesthesia and operating room availability, staffing, convenience, acuity of illness, and surgeon preference. Efforts to decrease LOS in surgery patients have focused largely on elective operations. We hypothesized that operative time of day would determine when patients were discharged after appendectomy.
Records of patients undergoing appendectomy between July, 2004 and June, 2005 were reviewed retrospectively. Operative date and time, hospital discharge date and time, operative findings, and postoperative complications were reviewed. Hospital LOS was calculated, and the Student t-test used to calculate significance.
A total of 199 patients underwent appendectomy during the study period. Twenty-three "outliers," with complicated appendicitis or significant co-morbidities (LOS 4-21 days, 76% perforated), were excluded. Length of stay in uncomplicated appendicitis was influenced significantly by the time of day the operation was performed. Length of stay was shortest if surgery was performed between 0001 and 0400 h (mean LOS 20 h 40 min). In contrast, LOS was 50% greater if the operation was performed during the day (mean LOS 32 h 24 min for cases performed between 0700 and 1500 h). No patients were discharged between 2100 and 0700 h. Surgical site infections occurred in fewer than 5% of patients, and white blood cell count did not predict LOS.
Operative time of day was a surprisingly important determinant of hospital LOS. Efforts to minimize LOS and optimize resource utilization should balance operating room availability, surgeon preferences, shift-dependent costs, nursing policies, and hospital systems.
急性阑尾炎是最常见的需要手术干预的外科感染疾病，住院时间通常较短。急性阑尾炎急诊阑尾切除术的时机取决于许多因素，包括麻醉和手术室的可用性、人员配备、便利性、病情严重程度以及外科医生的偏好。减少手术患者住院时间的努力主要集中在择期手术上。我们假设手术时间会决定阑尾切除术后患者的出院时间。
回顾性分析2004年7月至2005年6月期间接受阑尾切除术患者的记录。审查手术日期和时间、出院日期和时间、手术发现以及术后并发症。计算住院时间，并使用学生t检验计算显著性。
在研究期间共有199例患者接受了阑尾切除术。排除了23例患有复杂性阑尾炎或严重合并症的“异常值”患者（住院时间为4 - 21天，76%为穿孔性）。单纯性阑尾炎的住院时间受手术时间的显著影响。如果手术在00:01至04:00之间进行，住院时间最短（平均住院时间为20小时40分钟）。相比之下，如果手术在白天进行，住院时间会延长50%（07:00至15:00之间进行的病例平均住院时间为32小时24分钟）。没有患者在21:00至07:00之间出院。手术部位感染发生率低于5%，白细胞计数不能预测住院时间。
手术时间出人意料地是住院时间的重要决定因素。为尽量缩短住院时间并优化资源利用所做的努力应在手术室可用性、外科医生偏好、轮班相关成本、护理政策和医院系统之间取得平衡。
