Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Medical Centre.
Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Medical Centre, Leipzig.
Int J Surg. 2024 Aug 1;110(8):4850-4858. doi: 10.1097/JS9.0000000000001528.
Acute appendicitis is a global disease with high incidence. The main objective was to assess the association between time from admission to surgery (TAS) and surgery during emergency hours with operative outcome in light of conflicting evidence.
This is a retrospective population-wide analysis of hospital billing data (2010-2021) of all adult patient records of surgically treated cases of acute appendicitis in Germany by TAS. The primary outcome was a composite clinical endpoint (CCE; prolonged length of stay, surgical site infection, interventional draining after surgery, revision surgery, ICU admission and/or in-hospital mortality). Cases of complicated appendicitis were identified using diagnosis (ICD-10) and procedural codes (resection beyond appendectomy).
855 694 patient records were included, of which 27·6% (236,481) were complicated cases of acute appendicitis. 49·0% (418,821) were females and median age was 37 (interquartile range 22·5-51·5). Age, male sex, and comorbidity were associated with an increased proportion of CCE and in-hospital mortality. TAS was associated with a clinically relevant increase of CCE after 12 h in complicated appendicitis [Odd's ratio (OR), 1·19, 95% CI: 1·14-1·21] and after 24 h in uncomplicated appendicitis (OR 1·10, 95% CI: 1·02-1·19). Beyond the primary endpoint, the proportion of complicated appendicitis increased after TAS of 72 h. Surgery during emergency hours (6 pm-6.59 am) was associated with an increase of CCE and mortality (OR between 1·14 and 1·49). Age, female sex, night-time admission, weekend admission, a known previous surgery, obesity, and therapeutic anticoagulation were associated with delayed performance of surgery.
This work found an increase of a CCE after TAS of 12 h for complicated appendicitis and an increase of the CCE after TAS of 24 h for uncomplicated appendicitis with a stable proportion of complicated appendicitis in these time windows. Both CCE and mortality were increased if appendectomy was performed during emergency hours.
急性阑尾炎是一种全球范围内发病率较高的疾病。主要目的是评估从入院到手术的时间（TAS）与手术期间在急诊时与手术结果的关联，因为目前存在相互矛盾的证据。
这是一项针对德国所有接受手术治疗的急性阑尾炎患者的住院计费数据（2010 年至 2021 年）的回顾性人群分析，按照 TAS 进行。主要结局是复合临床终点（CCE；住院时间延长、手术部位感染、手术后介入引流、修正手术、入住重症监护病房和/或院内死亡）。使用诊断（ICD-10）和程序代码（阑尾切除术后的切除）来识别复杂的阑尾炎病例。
共纳入 855694 例患者记录，其中 27.6%（236481 例）为复杂的急性阑尾炎病例。49.0%（418821 例）为女性，中位年龄为 37 岁（四分位距 22.5-51.5）。年龄、男性和合并症与 CCE 和院内死亡率的比例增加有关。TAS 与复杂阑尾炎 12 小时后 CCE 的临床相关增加有关[比值比（OR），1.19，95%可信区间：1.14-1.21]和 24 小时后 CCE 的临床相关增加有关[比值比（OR），1.10，95%可信区间：1.02-1.19]。超出主要终点后，TAS 超过 72 小时后，复杂阑尾炎的比例增加。手术期间在急诊时（下午 6 点至 6.59 点）与 CCE 和死亡率的增加有关（比值比在 1.14 至 1.49 之间）。年龄、女性、夜间入院、周末入院、已知既往手术、肥胖和治疗性抗凝与手术延迟有关。
本研究发现，复杂阑尾炎 TAS 12 小时后 CCE 增加，TAS 24 小时后 CCE 增加，且这些时间窗口内复杂阑尾炎的比例稳定。如果在急诊时进行阑尾切除术，CCE 和死亡率都会增加。
