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Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study

Background and objective In many hospitals, the availability of operating theatres and access to senior surgical and anaesthetic support diminish during night hours. Therefore, urgent surgery is sometimes postponed until the following morning rather than performed overnight, if it is judged to be sa...

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Autores principales: Claydon, Oliver, Down, Billy, Kumar, Sidharth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994569/
https://www.ncbi.nlm.nih.gov/pubmed/35419245
http://dx.doi.org/10.7759/cureus.23034
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author Claydon, Oliver
Down, Billy
Kumar, Sidharth
author_facet Claydon, Oliver
Down, Billy
Kumar, Sidharth
author_sort Claydon, Oliver
collection PubMed
description Background and objective In many hospitals, the availability of operating theatres and access to senior surgical and anaesthetic support diminish during night hours. Therefore, urgent surgery is sometimes postponed until the following morning rather than performed overnight, if it is judged to be safe. In this study, we aimed to determine if a delay in laparoscopic appendicectomy in cases of acute appendicitis of over 12 hours, analogous to an overnight delay, correlated with worse patient outcomes. Our primary outcome was delayed discharge from the hospital. Our secondary outcomes were appendicitis severity, conversions, and postoperative complications. Methods We undertook a retrospective review of the medical records of patients who underwent laparoscopic appendicectomy for appendicitis at a UK district general hospital between 01/01/2018 and 30/08/2019. For each patient, clinical and demographic information, and time of hospital admission, surgery, and discharge were collected. Delayed discharge was defined as "time to discharge" >24 hours after surgery. Results A total of 446 patients were included in the study. In 137 patients (30.7%), "time to surgery" was under 12 hours; in 309 patients (69.3%) "time to surgery" was over 12 hours. Of note, 319 patients (71.5%) had a delayed discharge; 303 patients (67.9%) had complicated appendicitis, and 143 patients had severe appendicitis (32.1%). No statistically significant association between "time to surgery" and delayed discharge, appendicitis severity, conversion, or 30-day re-presentations was observed. Conclusion Time from admission to the start of appendicectomy did not affect patient outcomes. Short in-hospital delays in appendicectomy, such as an overnight delay, may be safe in certain patients and should be determined based on clinical judgement.
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spelling pubmed-89945692022-04-12 Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study Claydon, Oliver Down, Billy Kumar, Sidharth Cureus General Surgery Background and objective In many hospitals, the availability of operating theatres and access to senior surgical and anaesthetic support diminish during night hours. Therefore, urgent surgery is sometimes postponed until the following morning rather than performed overnight, if it is judged to be safe. In this study, we aimed to determine if a delay in laparoscopic appendicectomy in cases of acute appendicitis of over 12 hours, analogous to an overnight delay, correlated with worse patient outcomes. Our primary outcome was delayed discharge from the hospital. Our secondary outcomes were appendicitis severity, conversions, and postoperative complications. Methods We undertook a retrospective review of the medical records of patients who underwent laparoscopic appendicectomy for appendicitis at a UK district general hospital between 01/01/2018 and 30/08/2019. For each patient, clinical and demographic information, and time of hospital admission, surgery, and discharge were collected. Delayed discharge was defined as "time to discharge" >24 hours after surgery. Results A total of 446 patients were included in the study. In 137 patients (30.7%), "time to surgery" was under 12 hours; in 309 patients (69.3%) "time to surgery" was over 12 hours. Of note, 319 patients (71.5%) had a delayed discharge; 303 patients (67.9%) had complicated appendicitis, and 143 patients had severe appendicitis (32.1%). No statistically significant association between "time to surgery" and delayed discharge, appendicitis severity, conversion, or 30-day re-presentations was observed. Conclusion Time from admission to the start of appendicectomy did not affect patient outcomes. Short in-hospital delays in appendicectomy, such as an overnight delay, may be safe in certain patients and should be determined based on clinical judgement. Cureus 2022-03-10 /pmc/articles/PMC8994569/ /pubmed/35419245 http://dx.doi.org/10.7759/cureus.23034 Text en Copyright © 2022, Claydon et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle General Surgery
Claydon, Oliver
Down, Billy
Kumar, Sidharth
Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study
title Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study
title_full Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study
title_fullStr Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study
title_full_unstemmed Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study
title_short Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study
title_sort patient outcomes related to in-hospital delays in appendicectomy for appendicitis: a retrospective study
topic General Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994569/
https://www.ncbi.nlm.nih.gov/pubmed/35419245
http://dx.doi.org/10.7759/cureus.23034
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