Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, 220001, Nigeria.
Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
World J Surg. 2019 Dec;43(12):2967-2972. doi: 10.1007/s00268-019-05160-2.
Emergency abdominal operations carry significant risk of mortality and morbidity. The time of the day when such operations are performed has been suggested as a predictor of outcome. A retrospective comparison of outcomes of daytime and night-time emergency abdominal operations was conducted.
Clinical data of patients who had abdominal operations over a five-year period were obtained. Operations were classified as 'daytime' (group A) if performed between 8.00 am and 7.59 pm or 'night time' if performed between 8.00 pm and 7.59 am (group B). Post-operative outcomes were compared.
A total of 267 emergency abdominal operations were analysed: 161 (60.3%) were performed in the daytime while 106 (39.7%) were performed at night. The case mix in both groups was similar with appendectomies, bowel resections and closure of bowel perforations accounting for the majority. Baseline characteristics and intra-operative parameters were similar except that 'daytime' operations had more consultant participation (p = 0.01). Mortality rates (13.7% in group A and 12.3% in group B, p = 0.2), re-operation rates (9.3% in group A and 10.4% in group B, p = 0.7) and duration of hospital stay (group A-11.1 days, group B-12.4 days p = 0.4) were similar. ASA status, re-operation and admission into the intensive care unit were identified as predictors of mortality.
Timing of emergency abdominal operations did not influence outcomes. In resource-limited settings where access to the operating room is competitive, delaying operations till daytime may be counterproductive. Patients' clinical condition still remains the most important parameter guiding time of operation.
急诊腹部手术有较高的死亡率和发病率。手术时间被认为是预测结果的一个因素。本研究对日间和夜间急诊腹部手术的结果进行了回顾性比较。
收集了五年间进行腹部手术患者的临床资料。如果手术在上午 8 点至晚上 7 点 59 分之间进行，则将其归类为“日间”（A 组）；如果手术在晚上 8 点至次日上午 7 点 59 分之间进行，则将其归类为“夜间”（B 组）。比较术后结果。
共分析了 267 例急诊腹部手术：161 例（60.3%）在日间进行，106 例（39.7%）在夜间进行。两组的病例组合相似，阑尾切除术、肠切除术和肠穿孔修补术占大多数。基线特征和术中参数相似，不同之处在于“日间”手术有更多的顾问参与（p=0.01）。死亡率（A 组 13.7%，B 组 12.3%，p=0.2）、再次手术率（A 组 9.3%，B 组 10.4%，p=0.7）和住院时间（A 组 11.1 天，B 组 12.4 天，p=0.4）相似。ASA 状态、再次手术和入住重症监护病房被确定为死亡的预测因素。
手术时间并未影响结果。在资源有限的情况下，手术室的使用竞争激烈，将手术推迟到白天可能适得其反。患者的临床状况仍然是指导手术时间的最重要参数。
