Observational studySurgery2017
Time-of-day and appendicitis: Impact on management and outcomes.
Observational study in Surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed.
- Complicated Appendicitis in a Universal Healthcare System: Do Ethnic Disparities Persist?Health care analysis : HCA : journal of health philosophy and policy · 2026Article
- Article
- Demonstration of a new entity of non-perforated appendicitis through studying cluster of appendicitis.Scientific reports · 2022Article
- Daytime versus Nighttime in Acute Appendicitis.Diagnostics (Basel, Switzerland) · 2022Article
- Context is Key: Using the Audit Log to Capture Contextual Factors Affecting Stroke Care Processes.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2020Article
- Article
- Emergency department patient experience: Same location, same provider, different scores by different survey methods.World journal of emergency medicine · 2019Article
- A protocol for non-operative management of uncomplicated appendicitis.The journal of trauma and acute care surgery · 2018Article
- Outpatient Appendectomy in an Emergency Outpatient Surgery Unit 24 h a Day: An Intention-to-Treat Analysis of 194 Patients.World journal of surgery · 2017Observational
- Pediatric appendicitis: state of the art review.Pediatric surgery international · 2017Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
Abstract
backgroundObservational research has shown that delayed presentation is associated with perforation in appendicitis. Many factors that affect the ability to present for evaluation are influenced by time of day (eg, child care, work, transportation, and office hours of primary care settings). Our objective was to evaluate for an association between care processes or clinical outcomes and presentation time of day.
methodsThe study evaluated a prospective cohort of 7,548 adults undergoing appendectomy at 56 hospitals across Washington State. Relative to presentation time, patient characteristics, time to operation, imaging use, negative appendectomy, and perforation were compared using univariate and multivariate methodologies.
resultsOverall, 63% of patients presented between noon and midnight. More men presented in the morning; however, race, insurance status, comorbid conditions, and white blood cell count did not differ by presentation time. Daytime presenters (6 am to 6 pm) were less likely to undergo imaging (94% vs 98%, P < .05) and had a nearly 50% decrease in median preoperative time (6.0 h vs 8.7 h, P < .001). Perforation significantly differed by time-of-day. Patients who presented during the workday (9 am to 3 pm) had a 30% increase in odds of perforation compared with patients presenting in the early morning/late night (adjusted odds ratio 1.29, 95% confidence interval, 1.05-1.59). Negative appendectomy did not vary by time-of-day.
conclusionMost patients with appendicitis presented in the afternoon/evening. Socioeconomic characteristics did not vary with time-of-presentation. Patients who presented during the workday more often had perforated appendicitis compared with those who presented early morning or late night. Processes of care differed (both time-to-operation and imaging use). Time-of-day is associated with patient outcomes, process of care, and decisions to present for evaluation; this association has implications for the planning of the surgical workforce and efforts directed at quality improvement.
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Registered trials
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