Bom Wouter J, de Jonge Joske, Scheijmans Jochem C G, van Geloven Anna A W, Gans Sarah L, Boermeester Marja A, Bemelman Willem A, van Rossem Charles C
Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Department of Surgery, TergooiMC, 1213 XZ Hilversum, The Netherlands.
Diagnostics (Basel). 2022 Mar 23;12(4):788. doi: 10.3390/diagnostics12040788.
Little is known about patients with appendicitis presenting at nighttime. It is hypothesized that patients presented at night more frequently have a complicated (gangrenous or perforated) appendicitis and therefore develop more postoperative complications.
In this study data were used from the nationwide, prospective SNAPSHOT study appendicitis, including 1975 patients undergoing surgery for suspected appendicitis. This study included only adults. Two primary outcomes were defined: (A) The proportion of patients with complicated appendicitis and (B) the proportion of patients with a complication postoperatively presenting during daytime versus nighttime period. Analysis for both complicated and uncomplicated appendicitis was performed, and a multivariate model was used to correct for baseline characteristics and time to surgery.
In total, 1361 adult patients with appendicitis were analyzed. Both at nighttime and at daytime, 34% had complicated appendicitis. In patients presenting in the daytime, 12.1% developed a postoperative complication versus 18.6% for presentation at night ( = 0.008). In a multivariate analysis, the risk for a postoperative complication when presenting at night was significantly increased (adjusted OR 1.74; 95% CI 1.14-2.66, = 0.01). Surgery within eight hours after presentation does not lower this risk (adjusted OR 1.37; 95% CI 0.97-1.95, = 0.078).
Complicated appendicitis is seen as frequently during the day as at nighttime. For patients who present at nighttime with acute appendicitis, the risk of a postoperative complication is higher compared with a presentation at daytime. In multivariate analysis, nighttime presentation but not surgery within 8 h after presentation is independently associated with postoperative complication risk.
关于夜间就诊的阑尾炎患者的情况知之甚少。据推测，夜间就诊的患者更常患有复杂型（坏疽性或穿孔性）阑尾炎，因此术后并发症更多。
本研究使用了全国性前瞻性阑尾炎SNAPSHOT研究的数据，包括1975例因疑似阑尾炎接受手术的患者。本研究仅纳入成年人。定义了两个主要结局：（A）复杂型阑尾炎患者的比例；（B）术后出现并发症的患者在白天与夜间就诊的比例。对复杂型和非复杂型阑尾炎均进行了分析，并使用多变量模型校正基线特征和手术时间。
总共分析了1361例成年阑尾炎患者。无论在夜间还是白天，34%的患者患有复杂型阑尾炎。白天就诊的患者中，12.1%出现术后并发症，而夜间就诊的患者为18.6%（P = 0.008）。在多变量分析中，夜间就诊时术后并发症的风险显著增加（校正后的比值比为1.74；95%置信区间为1.14 - 2.66，P = 0.01）。就诊后8小时内进行手术并不能降低这种风险（校正后的比值比为1.37；95%置信区间为0.97 - 1.95，P = 0.078）。
复杂型阑尾炎在白天和夜间的出现频率相当。对于急性阑尾炎夜间就诊的患者，与白天就诊相比，术后并发症的风险更高。在多变量分析中，夜间就诊而非就诊后8小时内进行手术与术后并发症风险独立相关。
