title: Introduction of a new policy of no nighttime appendectomies: impact on appendiceal perforation rates and postoperative morbidity.
abstract: BACKGROUND
  Working hour limitations and tight health care budgets have posed significant challenges to emergency surgical services. Since 1 January 2010, surgical interventions at Berne University Hospital between 23:00 and 08:00 h have been restricted to patients with an expected serious adverse outcome if not operated on within 6 h. This study was designed to assess the safety of this new policy that restricts nighttime appendectomies (AEs).
  
  
  METHODS
  The patients that underwent AE from 1 January 2010 to 31 December 2011 ("2010-2011 group") were compared retrospectively with patients that underwent AE before introduction of the new policy (1 January 2006-31 December 2009; "2006-2009 group").
  
  
  RESULTS
  Overall, 390 patients were analyzed. There were 255 patients in the 2006-2009 group and 135 patients in the 2010-2011 group. Patients' demographics did not differ statistically between the two study groups; however, 45.9 % of the 2006-2009 group and 18.5 % of the 2010-2011 group were operated between 23:00 and 08:00 h (p < 0.001). The rates of appendiceal perforations and surgical site infections did not differ statistically between the 2006-2009 group and the 2010-2011 group (20 vs. 18.5 %, p = 0.725 and 2 vs. 0 %, p = 0.102). Additionally, no difference was found for the hospital length of stay (3.9 ± 7.4 vs. 3.4 ± 6.0 days, p = 0.586). However, the proportion of patients with an in-hospital delay of >12 h was significantly greater in the 2010-2011 group than in the 2006-2009 group [55.6 vs. 43.5 %, p = 0.024, odds ratio (95 % confidence interval 1.62 (1.1-2.47)].
  
  
  CONCLUSIONS
  Restricting AEs from 23:00 to 08:00 h does not increase the perforation rates and occurrence of clinical outcomes. Therefore, these results suggest that appendicitis may be managed safely in a semielective manner.
authors.affiliation: Department of Visceral Surgery and Medicine, Bern University Hospital, 3010, Bern, Switzerland, beat.schnuriger@gmail.com.
authors.forename: Beat
authors.initials: B
authors.lastname: Schnüriger
authors.forename: Jessica
authors.initials: J
authors.lastname: Laue
authors.forename: Dino
authors.initials: D
authors.lastname: Kröll
authors.forename: Daniel
authors.initials: D
authors.lastname: Inderbitzin
authors.forename: Christian A
authors.initials: CA
authors.lastname: Seiler
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000592:standards*; D001064:Appendicitis / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors