Risk and outcomes of 24-h delayed and weekend appendectomies

Time interval from hospital admission to operative intervention has been suggested as a crucial risk factor for a number of surgical procedures. In this study, we aim to compare postappendectomy outcomes for operations performed 24 h after admission or on the weekend to within 24 h and weekday operations, respectively.

A cross-sectional study using the Nationwide Inpatient Sample database, 2004-2009. The study population included patients who underwent appendectomy for acute appendicitis.

A total of 265,972 records were identified, of which 221,745 (83.4%) patients had appendectomy on the same day of admission, whereas 16.6% had the procedure the following day. Next day operations were more likely to be associated with postoperative complications (OR = 1.26, 95% CI = [1.19-1.33], P < 0.001). A hospital stay of >3 d 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 = 1.08, 95% CI = [1.02-1.14], P = 0.005). Teaching and urban hospitals were more likely to perform appendectomies on the day after admission (P < 0.05). Older patients (≥35 years), females, Blacks and Hispanics, and those on Medicaid or Medicare were all at higher risk of next day intervention (P < 0.01 each). The average cost of next day operations was higher compared to same day operations ($9890.11 ± 119.64 versus $8744.57 ± 77.67, P < 0.001).

Appendectomies performed 1 d after admission or on the weekend are associated with disadvantageous outcomes. Demographic factors, in addition to hospital attributes, place certain subpopulations at higher risk of next day appendectomies.