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Night-Time Presentation as an Independent Predictor of Unnecessary Appendectomy in Children: A Prospective Cohort
Mohamed Zouari1,2, Oumaima Jarboui1,2, Asma Issaoui1,2
1Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.
Background:
Unnecessary appendectomy (UA) remains an important quality indicator in pediatric emergency surgery, reflecting persistent diagnostic uncertainty despite advances in clinical assessment and imaging. The aim of this study was to identify predictors of UA in children.
Method:
This investigation was designed as a prospective cohort study involving consecutive pediatric patients who underwent appendectomy for suspected acute appendicitis during January 2022 through December 2025. Unnecessary appendectomy was defined as the removal of a macroscopically and histologically normal appendix.
Results:
A total of 653 children were included, of whom 53 (8.1%) underwent UA. The median age was 9.5 years, and males represented 66.8% of the cohort. Univariate analysis identified several factors potentially associated with UA. After adjustment for confounding variables, four factors remained independently associated with UA. These independent predictors included night-time admission (OR 3.51; 95% CI 1.83-6.71; p < 0.001), a NLR below 5 (OR 3.12; 95% CI 1.60-6.12; p = 0.001), a CRP level below 10 mg/L (OR 2.13; 95% CI 1.12-4.06; p = 0.021), and a negative US result (OR 5.67; 95% CI 2.98-10.76; p < 0.001).
Conclusion:
Unnecessary appendectomy in children is influenced not only by clinical and biological variables but also by contextual factors related to the timing of presentation. Recognition of night-time admission as a high-risk context may support more cautious decision-making strategies and help reduce avoidable surgical interventions in pediatric emergency care.
