Outcomes of Daytime and Night-Time Appendectomies: A Systematic Review and Meta-Analysis.

Lifang Shen, Liangfeng Zhang, Huili Shi
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Abstract

Background: Acute appendicitis is a common surgical emergency characterized by appendix inflammation. Surgery remains the gold standard for treatment with laparoscopy gaining in popularity. However, the optimal timing for appendectomy remains unclear. We are not aware of studies evaluating potential differences in clinical outcomes among appendectomies performed during the daytime and at night.

Methods: We followed the PRISMA guidelines and searched the ScienceDirect, Medline, and Google Scholar databases for studies published in English before June 2023. We included prospective and retrospective studies reporting appendectomy outcomes. We categorized the appendectomy procedure times as daytime or night-time based on each study's definitions. We extracted baseline characteristics and outcomes and assessed the quality of the studies included using the Newcastle-Ottawa Scale. We calculated pooled risk ratios (RRs) and weighted mean differences (WMDs) using random-effects models; and, we assessed heterogeneity using the I2 statistic.

Results: We analyzed data from 12 studies for systematic review ( n =19,183) including daytime ( n =11,839) and night-time ( n =7344) appendectomies. For the meta-analysis, we included 9 studies, that evaluated outcomes such as mortality (pooled RR, 0.44; 95% CI, 0.09-2.01; I2 =43.7%; P =0.11), hospital stay (WMD, -0.02; 95% CI, -0.24 to 0.20; I2 =93.3%; P <0.001), and complications (pooled RR, 0.96; 95% CI, 0.64-1.45; I2 =65.1%; P =0.02). We found similar mortality rates, hospital stay lengths, and complications for the appendectomies, regardless of the time of day of the operation. The baseline characteristics of the patients were also similar, except for the duration of symptoms and the presence of an appendiceal abscess.

Conclusion: Our results showed that the timing of an appendectomy (daytime vs. night-time) does not significantly affect its outcomes. Surgeon availability or fatigue, and patient severity may not significantly impact the operation results. Standardized protocols and perioperative care ensure consistent outcomes.

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日间和夜间阑尾切除术的结果:系统回顾与元分析》。
背景:急性阑尾炎是以阑尾发炎为特征的常见外科急症。手术仍是治疗的金标准,腹腔镜手术越来越受欢迎。然而,阑尾切除术的最佳时机仍不明确。我们尚未发现有研究对白天和夜间进行阑尾切除术的临床结果的潜在差异进行评估:我们遵循 PRISMA 指南,在 ScienceDirect、Medline 和 Google Scholar 数据库中检索了 2023 年 6 月之前发表的英文研究。我们纳入了报告阑尾切除术结果的前瞻性和回顾性研究。我们根据每项研究的定义将阑尾切除手术时间分为白天和夜间。我们提取了基线特征和结果,并使用纽卡斯尔-渥太华量表评估了纳入研究的质量。我们使用随机效应模型计算了汇总风险比(RR)和加权平均差(WMD),并使用 I2 统计量评估了异质性:我们分析了12项系统综述研究的数据(n=19183),包括日间(n=11839)和夜间(n=7344)阑尾切除术。在荟萃分析中,我们纳入了 9 项研究,这些研究评估了死亡率(汇总 RR,0.44;95% CI,0.09-2.01;I2=43.7%;P=0.11)、住院时间(WMD,-0.02;95% CI,-0.24 至 0.20;I2=93.3%;P 结论:我们的研究结果表明,阑尾切除术的时间(白天与夜间)对手术效果并无明显影响。外科医生的可用性或疲劳程度以及患者的严重程度可能对手术结果没有明显影响。标准化方案和围手术期护理可确保手术结果的一致性。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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