Yetişkin hastalarda gece veya gündüz yapılan laparoskopik apendektomilerin klinik sonuçlarının irdelenmesi

Öz

Amaç: Akut apandisit en sık görülen cerrahi acil durumlardan biridir ve laparoskopik apendektomi günün her saatinde sıklıkla uygulanmaktadır. Bu çalışmanın amacı, laparoskopik apendektomi sonrası perioperatif ve postoperatif sonuçlar üzerinde ameliyat zamanlamasının etkisini değerlendirmektir. 
Gereç ve yöntem: Bu retrospektif çalışmaya, Ocak 2023 ile Aralık 2024 tarihleri arasında Pamukkale Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nda akut apandisit nedeniyle laparoskopik apendektomi geçiren hastalar dahil edilmiştir. Hastalar, ameliyat saatine göre gündüz grubu (08:00–20:00) ve gece grubu (20:00–08:00) olarak sınıflandırılmıştır. Demografik özellikler, semptom süresi, ameliyat süresi, konversiyon oranı, dren kullanımı, morbidite, mortalite, yeniden yatış ve hastanede kalış süresi analiz edilmiştir.
Bulgular: Çalışmaya toplam 114 hasta dahil edildi; bunların 62’si (%54,4) kadın, 52’si (%45,6) erkekti. 67 hastada (%58,8) gündüz ameliyatı yapılırken, 47 hastada (%41,2) gece ameliyatı gerçekleştirildi. Hasta özellikleri gruplar arasında benzerdi. Semptomların başlamasından hastaneye yatışa kadar geçen süre gündüz ve gece grupları arasında benzerdi (1,85’e karşı 1,91 gün, p=0,829). Ortalama ameliyat süresi gündüz grubunda 64,5±14,3 dakika, gece grubunda ise 59,6±17,7 dakikaydı (p=0,106). Gece grubunda iki hastada (%4,3) açık cerrahiye geçiş görülürken, gündüz grubunda hiç görülmedi (p=0,168). Dren yerleştirme, postoperatif morbidite, hastanede kalış süresi, yeniden yatış veya mortalite açısından anlamlı bir fark gözlenmedi.
Sonuç: Gece saatlerinde gerçekleştirilen laparoskopik apendektomi, gündüz yapılan cerrahi kadar güvenli ve etkili olup benzer perioperatif ve postoperatif sonuçlar sağlamaktadır.

Anahtar Kelimeler

• Yetişkin
• akut apandisit
• laparoskopik apendektomi
• gündüz cerrahisi
• gece cerrahisi

Evaluation of clinical outcomes of laparoscopic appendectomies performed during daytime or nighttime in adult patients

Öz

Purpose: Acute appendicitis is one of the most common surgical emergencies, and laparoscopic appendectomy is frequently performed at any time of day. The aim of this study was to evaluate the effect of operation timing on perioperative and postoperative outcomes following laparoscopic appendectomy. 
Materials and methods: This retrospective study included patients who underwent laparoscopic appendectomy for acute appendicitis at the Department of General Surgery, Pamukkale University Faculty of Medicine, between January 2023 and December 2024. Patients were classified into a daytime group (08:00–20:00) and a nighttime group (20:00–08:00) according to the timing of surgery. Demographic characteristics, symptom duration, operative time, conversion rate, drain usage, morbidity, mortality, readmission, and length of hospital stay were analyzed.
Results: A total of 114 patients were included, of whom 62 (54.4%) were female and 52 (45.6%) were male. Daytime surgery was performed in 67 patients (58.8%), whereas 47 patients (41.2%) underwent nighttime surgery. Patient characteristics were comparable between groups. The interval from symptom onset to hospital admission was similar between the daytime and nighttime groups (1.85 vs. 1.91 days, p=0.829). Mean operative time was 64.5±14.3 minutes in the daytime group and 59.6±17.7 minutes in the nighttime group (p=0.106). Conversion to open surgery occurred in two patients (4.3%) in the nighttime group and none in the daytime group (p=0.168). No significant differences were observed regarding drain placement, postoperative morbidity, length of hospital stay, readmission, or mortality.
Conclusion: Nighttime laparoscopic appendectomy is as safe and effective as daytime surgery, with comparable perioperative and postoperative outcomes.

Anahtar Kelimeler

• Adult
• acute appendicitis
• laparoscopic appendectomy
• daytime surgery
• nighttime surgery

Kaynakça

1. Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278-1287. doi:10.1016/S0140-6736(15)00275-5
2. McBurney C. IV. The Incision Made in the Abdominal Wall in Cases of Appendicitis, with a Description of a New Method of Operating. Ann Surg. 1894;20(1):38-43. doi:10.1097/00000658-189407000-00004
3. GlobalSurg Collaborative. Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study. Surg Endosc. 2018;32(8):3450-3466. doi:10.1007/s00464-018-6064-9
4. Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;(10):CD001546. doi:10.1002/14651858.CD001546.pub3
5. Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27. doi:10.1186/s13017-020-00306-3
6. Jalava K, Sallinen V, Lampela H, et al. Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomised controlled trial. Lancet. 2023;402(10412):1552-1561. doi:10.1016/S0140-6736(23)01311-9
7. Gorter RR, Eker HH, Gorter-Stam MA, et al. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016;30(11):4668-4690. doi:10.1007/s00464-016-5245-7
8. Alore EA, Ward JL, Todd SR, et al. Population-level outcomes of early versus delayed appendectomy for acute appendicitis using the American College of Surgeons National Surgical Quality Improvement Program. J Surg Res. 2018;229:234-242. doi:10.1016/j.jss.2018.04.011

9. Kim M, Kim SJ, Cho HJ. Effect of surgical timing and outcomes for appendicitis severity. Ann Surg Treat Res. 2016;91(2):85-89. doi:10.4174/astr.2016.91.2.85
10. van Dijk ST, van Dijk AH, Dijkgraaf MG, Boermeester MA. Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis. Br J Surg. 2018;105(8):933-945. doi:10.1002/bjs.10873
11. Li J, Xu R, Hu DM, Zhang Y, Gong TP, Wu XL. Effect of Delay to Operation on Outcomes in Patients with Acute Appendicitis: a Systematic Review and Meta-analysis. J Gastrointest Surg. 2019;23(1):210-223. doi:10.1007/s11605-018-3866-y
12. Sturm L, Dawson D, Vaughan R, et al. Effects of fatigue on surgeon performance and surgical outcomes: a systematic review. ANZ J Surg. 2011;81(7-8):502-509. doi:10.1111/j.1445-2197.2010.05642.x
13. Tuwairgi K, Selter J, Sikder S. Assessment of surgeon fatigue by surgical simulators. Open Access Surg. 2015;8:43-50. doi:10.2147/OAS.S77711
14. Fugazzola P, Ceresoli M, Agnoletti V, et al. The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition). World J Emerg Surg. 2020;15(1):19. doi:10.1186/s13017-020-00298-0
15. Althoff FC, Wachtendorf LJ, Rostin P, et al. Effects of night surgery on postoperative mortality and morbidity: a multicentre cohort study. BMJ Qual Saf. 2021;30(8):678-688. doi:10.1136/bmjqs-2020-011684
16. Cortegiani A, Ippolito M, Misseri G, et al. Association between night/after-hours surgery and mortality: a systematic review and meta-analysis. Br J Anaesth. 2020;124(5):623-637. doi:10.1016/j.bja.2020.01.019
17. Yang N, Elmatite WM, Elgallad A, Gajdos C, Pourafkari L, Nader ND. Patient outcomes related to the daytime versus after-hours surgery: A meta-analysis. J Clin Anesth. 2019;54:13-18. doi:10.1016/j.jclinane.2018.10.019
18. Tago T, Shimoda M, Imazato R, et al. Possibility for avoidance of urgent nighttime operations for acute appendicitis in a regional core university hospital. Asian J Endosc Surg. 2022;15(1):22-28. doi:10.1111/ases.12953
19. Canal C, Lempert M, Birrer DL, Neuhaus V, Turina M. Short-term outcome after appendectomy is related to preoperative delay but not to the time of day of the procedure: A nationwide retrospective cohort study of 9224 patients. Int J Surg. 2020;76:16-24. doi:10.1016/j.ijsu.2020.02.001
20. Pogorelić Z, Janković Marendić I, Čohadžić T, Jukić M. Clinical Outcomes of Daytime Versus Nighttime Laparoscopic Appendectomy in Children. Children (Basel). 2023;10(4):750. doi:10.3390/children10040750
21. Tang G, Wang J, Chen R, Zhang J, Zhou R. Daytime versus nighttime appendectomy in term of complications and clinical outcomes: a meta-analysis. Int J Colorectal Dis. 2024;39(1):131. doi:10.1007/s00384-024-04705-9
22. Mönttinen T, Kangaspunta H, Laukkarinen J, Ukkonen M. Nighttime Appendectomy is Safe and has Similar Outcomes as Daytime Appendectomy: A Study of 1198 Appendectomies. Scand J Surg. 2021;110(2):227-232. doi:10.1177/1457496920938605
23. Busch M, Gutzwiller FS, Aellig S, Kuettel R, Metzger U, Zingg U. In-hospital delay increases the risk of perforation in adults with appendicitis. World J Surg. 2011;35(7):1626-1633. doi:10.1007/s00268-011-1101-z