已建立的急性外科手术单元：减少夜间阑尾切除术而不增加发病率。

The Established Acute Surgical Unit: A reduction in nighttime appendicectomy without increased morbidity.

机构信息

Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.

Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Whiteley-Martin Research Centre, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia.

出版信息

Int J Surg. 2017 Jul;43:81-85. doi: 10.1016/j.ijsu.2017.05.045. Epub 2017 May 24.

DOI:10.1016/j.ijsu.2017.05.045

PMID:28552813

Abstract

INTRODUCTION

Nighttime surgery for non-life threatening disease has been associated with poorer outcomes, but delaying surgery for acute appendicitis may also be detrimental. The aim was to assess the effect of the Acute Surgical Unit [ASU] model on nighttime surgery rates and outcomes for patients undergoing appendicectomy.

METHOD

A retrospective review of medical records of patients having an appendicectomy. Primary outcomes were nighttime surgery rate, time from presentation to surgery, perforation rate, complication rate and length of stay.

RESULTS

There was a large increase in workload: Pre ASU 278, Early ASU 553 and Est. ASU 923. There was a significant decrease in nighttime surgery rates: Pre ASU 46.9%, Early ASU 30.2% and Established ASU 28.3% (Pre vs. Early p < 0.001; Pre vs. Est. p < 0.001; Early vs. Est p = 0.004). When comparing the Pre ASU and Established ASU groups there was an increase in mean time from presentation to surgery (Pre 14.43 Hrs, Est. 18.65 Hrs; p = 0.001), an increase in perforation rate that was not significant (Pre 9.8%, Est. 14.2%; p = 0.05) and similar complication rates (Pre 8.66%, Est. 7.04%; p = 0.37). There was a significant decrease in length of stay between the Early and Established ASU groups (Pre 3.1 D, Est. 2.8D, p = 0.01). At our institution there was no statistically significant increase in complications for patients undergoing nighttime appendicectomy (Night 10.0%, Day 8.2%; p = 0.16).

CONCLUSION

There was a significant decrease in nighttime surgery, without any difference in morbidity or length of stay for patients treated within the Established ASU (compared to Pre ASU group).

LEVEL OF EVIDENCE

IIb.

摘要

简介

非危及生命的疾病在夜间进行手术与较差的结果相关，但延迟急性阑尾炎手术也可能有害。目的是评估急性外科病房（ASU）模式对接受阑尾切除术的患者夜间手术率和结果的影响。

方法

回顾性分析接受阑尾切除术的患者的病历。主要结果是夜间手术率、从就诊到手术的时间、穿孔率、并发症发生率和住院时间。

结果

工作量大幅增加：ASU 前 278 例，ASU 早期 553 例，ASU 建立后 923 例。夜间手术率显著下降：ASU 前 46.9%，ASU 早期 30.2%，ASU 建立后 28.3%（ASU 前与 ASU 早期比较，p<0.001；ASU 前与 ASU 建立后比较，p<0.001；ASU 早期与 ASU 建立后比较，p=0.004）。与 ASU 前和 ASU 建立后两组相比，从就诊到手术的平均时间增加（ASU 前 14.43 小时，ASU 建立后 18.65 小时；p=0.001），穿孔率虽有所增加但无统计学意义（ASU 前 9.8%，ASU 建立后 14.2%；p=0.05），并发症发生率相似（ASU 前 8.66%，ASU 建立后 7.04%；p=0.37）。ASU 早期与 ASU 建立后两组之间的住院时间显著缩短（ASU 前 3.1 天，ASU 建立后 2.8 天，p=0.01）。在我们的机构中，夜间行阑尾切除术的患者并发症发生率没有统计学显著增加（夜间 10.0%，日间 8.2%；p=0.16）。