Z. Al-Qurayshi1, E. Kandil1 1Tulane University School Of Medicine,Surgery,New Orleans, LA, USA
Introduction: Time from hospital admission to operative intervention has been suggested to be a crucial risk factor for a number of surgical interventions. In this study, we aim to compare the post-appendectomy outcomes for operations performed on the next day of admission or on weekend to same day and weekday operations respectively.
Methods: A cross-sectional study utilizing the Nationwide Inpatient Sample (NIS) database for 2004-2009. ICD-9 codes were used to identify all patients who underwent appendectomy for acute appendicitis.
Results: 341,376 discharge records were included. 55,485 (16.3%) patients had appendectomy on the next day of admission, while 70,701 (24.7%) patients had the operation on weekends. Next day operations were more likely to be associated with postoperative complications [OR: 1.22, 95%CI (1.14, 1.30), p<0.001]. A hospital stay of more than 3 days was also more common for next day interventions (p<0.001). Appendectomies performed on weekends had a higher risk of complications compared to other days [OR: 1.09, 95%CI (1.02, 1.17), p=0.009]. Teaching, and urban hospitals were more likely to perform the appendectomy on the next day of admission (p<0.05). Older patients (>65 years), females, Blacks and Hispanics, and those on Medicaid , all were at higher risk of next day intervention (p<0.001 each). The average cost of next day operations was higher compared to same day operations ($9,422.10±138.25 vs. $8,278.00±84.75, p<0.001).
Conclusion: Appendectomies performed on next day of admission or on weekend are associated with disadvantageous outcomes. Demographic and economic factors, besides the hospital attributes, place certain subpopulations at higher risk of next day appendectomies.