Department of Surgery Beaumont Hospital, Dublin, Ireland.
Royal College of Surgeons in Ireland, 123 St Stephens Green Dublin 2, Dublin, Ireland.
World J Emerg Surg. 2024 Jun 14;19(1):24. doi: 10.1186/s13017-024-00549-4.
Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes.
To perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed (2), time elapsed from symptom onset to hospital presentation (patient time) (3), time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes.
A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into < 24 h, 24-48 h and > 48 h. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed.
Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were < 24 h. Readmission and mortality rates were significantly better when the hospital time was < 48 h. SSI, operative time, and the rate of perforation were comparable in all groups.
Appendicectomy within 24 h of hospital admission is associated with improved outcomes compared to patients having surgery 24-48 and > 48 h after admission. The time-of-day which surgery is performed does not impact outcomes.
阑尾切除术仍然是治疗阑尾炎的标准方法。对于应该在何时进行手术以避免不良后果，目前还缺乏明确的认识。
进行系统评价和网络荟萃分析，评估手术时间（1）、从症状发作到医院就诊的时间（患者时间）（2）、从医院就诊到手术的时间（医院时间）（3）以及从症状发作到手术的时间（总时间）（4）对阑尾切除术结果的影响。
按照 PRISMA-NMA 指南进行系统评价。手术时间分为白天、傍晚和夜间。其他组分为<24 小时、24-48 小时和>48 小时。分析复杂阑尾炎、手术时间、穿孔、术后并发症、手术部位感染（SSI）、住院时间（LOS）、再入院率和死亡率的发生率。
纳入了 16 项研究，共 232678 名患者。手术时间对结果没有影响。当医院时间和总时间<24 小时时，复杂阑尾炎、术后并发症和 LOS 的发生率显著降低。当医院时间<48 小时时，再入院率和死亡率显著降低。所有组的 SSI、手术时间和穿孔率均无差异。
与入院后 24-48 小时和>48 小时手术的患者相比，入院后 24 小时内进行阑尾切除术与改善结果相关。手术时间对结果没有影响。
