Acute Uncomplicated Appendicitis

Case Time of Day Influences Hospital Length of Stay

Acute appendicitis is the most common surgical infection requiring an operation, and length of stay (LOS) can vary widely. While efforts to shorten LOS have focused on elective operations, this study determined that operative time of day had the greatest impact.

The timing of emergency appendectomies for acute appendicitis depends on many factors, including operating room availability, staffing, convenience, acuity of illness and surgeon preference. Given the current focus on health care performance and resource utilization, optimal management of this common disease becomes increasingly important. This study analyzed whether operative time of day would determine when patients were discharged after appendectomy. Records of patients undergoing appendectomy (n = 199, 2004-2005) were reviewed retrospectively.

Key Findings:

  • Regardless of operative technique, patient age or patient sex, the LOS typically was short.
  • Operative time of day was an important determinant of hospital LOS and hospital charges for patients with uncomplicated appendicitis.
  • LOS was shortest if surgery was performed between 0001 and 0400 h, and 50 percent greater if operation was performed during the day.

A study limitation is the fact that patients at research institutions are not discharged between the hours of 2100 and 0700. Patients operated on in the afternoon had a longer LOS, as they miss the 2100 h cutoff. Potential solutions include ensuring that hospitals create systems that allow patients to be discharged safely and comfortably at any time.