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. 2022 Mar 23;12(4):788.
doi: 10.3390/diagnostics12040788.

Daytime versus Nighttime in Acute Appendicitis

Wouter J Bom  1   2 , Joske de Jonge  2 , Jochem C G Scheijmans  1 , Anna A W van Geloven  2 , Sarah L Gans  1 , Marja A Boermeester  1 , Willem A Bemelman  1 , Charles C van Rossem  3 , On Behalf Of The Snapshot
Affiliations

Daytime versus Nighttime in Acute Appendicitis

Wouter J Bom et al. Diagnostics (Basel). .

Abstract

Background: 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.

Methods: 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.

Results: 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 (p = 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, p = 0.01). Surgery within eight hours after presentation does not lower this risk (adjusted OR 1.37; 95% CI 0.97-1.95, p = 0.078).

Conclusion: 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.

Keywords: complicated appendicitis; day; night; uncomplicated appendicitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of included patients.
Figure 2
Figure 2
Hourly proportion (from total over 24 h) of patients with appendicitis presenting at the emergency department, for uncomplicated and complicated appendicitis.
Figure 3
Figure 3
Proportion of patients with a complicated appendicitis relative to all patients with appendicitis per hour. Average difference day vs. night is 34.5% vs. 34.2% (p = 0.93), per hour p = 0.44.
See this image and copyright information in PMC

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