Acute Uncomplicated Appendicitis: Case Time of Day Influences Hospital Length of Stay

Crandall, Marie; Shapiro, Michael B.; Worley, Marci; West, Michael A.

doi:10.1089/sur.2008.0004

Cited by 17 publications

(8 citation statements)

References 19 publications

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“…A 2005 study demonstrated that patients who had operations earlier in the day had longer post-operative length of stay. 10 Bhangu et al ., in a setting much different from SCOAP hospitals, showed that NA, use of laparoscopy, and consultant ( i.e. , attending) presence in the OR varied substantially by time-of-day in a group of 95 hospitals, mostly in the United Kingdom.…”

Section: Discussionmentioning

confidence: 99%

Time-of-day and appendicitis: Impact on management and outcomes

Drake

Mottey

Castelli

et al. 2017

Surgery

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Background Observational research has shown that delayed presentation is associated with perforation in appendicitis. Many factors that impact the ability to present for evaluation are influenced by time-of-day; for example, child care, work, transportation, and primary care office hours. Our objective was to evaluate for an association between care processes or clinical outcomes and presentation time. Methods Prospective cohort of 7,548 adults undergoing appendectomy at 56 hospitals across Washington State. Relative to presentation time, patient characteristics, time to surgery, imaging use, negative appendectomy (NA), and perforation were compared using univariate and multivariate methodologies. Results Overall, 63% of patients presented between noon and midnight. More men presented in the morning; however, race, insurance status, co-morbid conditions, and WBC count did not differ by presentation time. Daytime presenters (6AM-6PM) were less likely to undergo imaging (94% vs. 98% p<0.05) and had a nearly 50% decrease in median pre-operative time (6.0h vs. 8.7h p<0.001). Perforation significantly differed by time-of-day. Patients who presented during the workday (9AM-3PM) had a 30% increase in odds of perforation compared to early morning/late night presenters (adjusted OR 1.29, 95%CI 1.05–1.59). NA did not vary by time-of-day. Conclusions Most patients with appendicitis presented in afternoon/evening. Socioeconomic characteristics did not vary with time-of-presentation. Patients who presented during the workday more often had perforated appendicitis compared to those who presented early morning or late night. Processes of care differed (both time-to-surgery and imaging use). Time-of-day is associated with patient outcomes, process of care, and decisions to present for evaluation; this has implications for surgical workforce planning and quality improvement efforts.

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Section: Discussionmentioning

confidence: 99%

Time-of-day and appendicitis: Impact on management and outcomes

Drake

Mottey

Castelli

et al. 2017

Surgery

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“…Within these time frames, the probability of a successful laparoscopic procedure is higher and both LOS and hospital costs are lower. [16–18] Delays beyond 18 h do not appear to increase the incidence of surgical site infections or other complications, but are costly and increase the patient's LOS. It is unclear why there was delay in surgery for patients in this group (Group 4) of patients.…”

Section: Discussionmentioning

confidence: 99%

Ideal timing of surgery for acute uncomplicated appendicitis

et al. 2013

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Background:Early surgery for appendicitis is thought to avoid complications associated with appendiceal rupture.Aims:This study was to evaluate the effect of timing of surgery on complications, length of stay (LOS) and cost in patients undergoing appendectomy.Materials and Methods:Retrospective review of 396 patients with appendectomies from January 1, 2005 to December 31, 2007 was performed. Demographic data, time of presentation, physical findings, diagnostic data, operating room times, LOS, cost and complications were collected. Patients were divided into 4 groups based on time from presentation to appendectomy.Results:Pathology confirmed appendicitis in 354 (89%) patients. Most patients (90%) had surgery within 18 h of presentation. Timing of surgery did not affect the incidence of purulent peritonitis (P = 0.883), abscess (P = 0.841) or perforation (P = 0.464). LOS was significantly shorter for patients with emergency department registration to operating room times less than 18 h (P < 0.0001). Costs were significantly higher for patients with times to operating room greater than 18 h (P < 0.001).Conclusion:Timing of surgery did not affect the incidence of complications or perforated appendicitis. However, delay in surgical consultation and surgery are associated with increased LOS and increased hospital costs. The optimal timing of appendectomy for uncomplicated acute appendicitis appears to be within 18 h of emergency department presentation.

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“…Mean LOS for AA and AC from 2011 to 2017 were one and three days, respectively; one day less than the two additional Winnipeg hospitals performing these procedures. Multiple factors have been shown to impact LOS for AA patients, including time of presentation, perforation, and time of surgery [21-22].…”

Section: Discussionmentioning

confidence: 99%

The Impact of an Acute Care Surgical Service on the Quality and Efficiency of Care Outcome Indicators for Patients with General Surgical Emergencies

Hardy

Metcalfe

Clouston

et al. 2019

Cureus

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Background Acute care surgery (ACS) models address high volumes of emergency general surgery and emergency room (ER) overcrowding. The impact of ACS service model implementation on the quality and efficiency of care (EOC) outcomes in acute appendicitis (AA) and acute cholecystitis (AC) cohorts was evaluated. Methods A retrospective chart review (N=1,229) of adult AA and AC patients admitted prior to (pre-ACS; n=507; three hospitals; 2007) and after regionalization (R-ACS; n=722; one hospital; 2011). Results R-ACS time to ER physician assessment was significantly longer for AA (3.4 ± 2.3 versus 2.4 ± 2.6 hr; p ≤ 0.001). Surgical response times (1.3 ± 1.2 vs 2.6 ± 4.3 hr for AA; 1.8 ± 1.5 vs 4.1 ± 5.0 hr for AC; p ≤ 0.0001) and acquisition of imaging (4.1 ± 4.1 vs 6.9 ± 9.9 hr for AA, p ≤ 0.0001; 7.8 ± 1.9 vs 13.2 ± 18.5 hr for AC, p ≤ 0.008) occurred significantly faster with R-ACS. R-ACS resulted in a significant increase in night-time appendectomies (21.7% vs 11.1%; p ≤ 0.002), perforated appendices (29.1 % vs 18.9 %; p ≤ 0.006), 30-day readmissions (4.56% vs 0.82%; p ≤ 0.01), and lower rate of intraoperative complications for AC patients (2.78% vs 7.69%; p ≤ 0.02). Conclusions Despite the increased volume of patients seen with the implementation of R-ACS, surgical assessments and diagnostic imaging were significantly more prompt. EOC measures were maintained. Worse AA outcomes highlight areas for improvement in delivering R-ACS.

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Acute Uncomplicated Appendicitis: Case Time of Day Influences Hospital Length of Stay

Abstract: Operative time of day was a surprisingly important determinant of hospital LOS. Efforts to minimize LOS and optimize resource utilization should balance operating room availability, surgeon preferences, shift-dependent costs, nursing policies, and hospital systems.

Cited by 17 publications

References 19 publications

Time-of-day and appendicitis: Impact on management and outcomes

Time-of-day and appendicitis: Impact on management and outcomes

Ideal timing of surgery for acute uncomplicated appendicitis

The Impact of an Acute Care Surgical Service on the Quality and Efficiency of Care Outcome Indicators for Patients with General Surgical Emergencies

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