背景:阑尾炎是全球最常见的急性外科疾病之一。然而,夜间阑尾切除术与患者发病率和死亡率之间的关系尚不清楚.这项研究旨在比较夜间和白天阑尾切除术后的结果。
方法:PubMed,Embase,科克伦图书馆,和截至2024年3月26日的WebofScience数据库(更新于2024年7月1日)进行了搜索。主要结果是术后并发症和死亡率。次要结果包括术中并发症,再操作,重新接纳,转换为剖腹手术,住院时间和手术时间。计算平均差(MD)或比值比(OR)和95%置信区间。
结果:共纳入15项研究,共33,596名患者。夜间和日间阑尾切除术的总体术后并发症发生率没有差异(OR0.93,95%CI0.87,1.00,14项研究),死亡率(OR1.70,95%CI0.37,7.88,7项研究),术中并发症(OR0.88,95%CI0.08,9.86;2项研究),再手术(OR0.39,95%CI0.06,2.55;3项研究)和再入院(OR0.86,95%CI0.65,1.13;I2=0%,5项研究)。然而,与日间相比,夜间行阑尾切除术的患者转换为剖腹手术的风险(OR1.92,95%CI1.12,3.29;6项研究)显著升高.
结论:与日间阑尾切除术相比,夜间手术的术后死亡率和并发症发生率没有增加或差异。然而,未来的研究应评估夜间转化率较高的原因.
BACKGROUND: Appendicitis is one of the most common acute surgical conditions globally. However, the association between nighttime appendectomy and patients\' morbidity and mortality is unclear. This study aims to compare outcomes following nighttime versus daytime appendectomy.
METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases up to March 26, 2024 (updated on July 1, 2024) were searched. The primary outcomes were postoperative complications and mortality. Secondary outcomes included intraoperative complications, reoperation, readmission, conversion to laparotomy, hospital stay and operation time. Mean difference (MD) or odds ratios (OR) and 95% confidence intervals were calculated.
RESULTS: Fifteen studies totaling 33,596 patients were included. There were no differences between nighttime and daytime appendectomy for rates of overall postoperative complications (OR 0.93, 95% CI 0.87, 1.00, 14 studies), mortality (OR 1.70, 95% CI 0.37, 7.88, 7 studies), intraoperative complications (OR 0.88, 95% CI 0.08, 9.86; 2 studies), reoperation (OR 0.39, 95% CI 0.06, 2.55; 3 studies) and readmission (OR 0.86, 95% CI 0.65, 1.13; I2 = 0%, 5 studies). However, the conversion to laparotomy risks (OR 1.92, 95% CI 1.12, 3.29; 6 studies) among patients who underwent appendectomy during nighttime was significantly elevated compared to daytime.
CONCLUSIONS: There was no increased risk or difference in postoperative mortality and complication rates associated with nighttime compared with daytime appendectomy. However, future studies should assess the reasons for higher conversion rates during the night.