title: No Circadian Variation in Surgeons' Ability to Diagnose Acute Appendicitis.
abstract: OBJECTIVE
  To examine if there were circadian variations in surgeons' ability to diagnose acute appendicitis.
  
  
  METHODS
  Retrospective database study of all patients admitted to an acute surgical procedure under the potential diagnosis of acute appendicitis in a 4-year period. The day was divided into 2 time intervals, day to evening hours (08:00-23:59) and night hours (00:00-07:59). Relevant data regarding the admission and surgical procedures were categorized into these 2 time intervals.
  
  
  METHODS
  Department of Surgery at a Danish university hospital in Copenhagen.
  
  
  METHODS
  A total of 2366 patients were included. There were no age limitations or selection in sex.
  
  
  RESULTS
  There was no significant difference in the ability to diagnose appendicitis in day-evening hours vs night hours (p = 0.391), nor was any significant difference found on weekdays (Monday-Thursday) vs weekends (Friday-Sunday) (p = 0.278). There were no differences in duration of the procedures, rate of conversion, or severity of postoperative surgical complications between the 2 groups. More patients underwent diagnostic imaging during day to evening hours compared with night hours (308 vs 46; p = 0.014). The use of imaging had no effect on the ability to diagnose appendicitis. Male sex showed a higher probability of the diagnosis being appendicitis compared with other or no pathology (odds ratio: 3.094; p < 0.001). Age between 40 and 80 years was significantly associated with a higher probability of the diagnosis being appendicitis compared with other or no pathology. The negative appendectomy rate was 10.5%.
  
  
  CONCLUSIONS
  We found no difference in the surgeons' ability to diagnose acute appendicitis during night hours compared with day to evening hours.
authors.affiliation: Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark. Electronic address: dr.bech@gmail.com.
authors.forename: Anders Bech
authors.initials: AB
authors.lastname: Jørgensen
authors.affiliation: Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Ilda
authors.initials: I
authors.lastname: Amirian
authors.affiliation: Department of Surgery, Køge Hospital, Køge, Denmark.
authors.forename: Sara Kehlet
authors.initials: SK
authors.lastname: Watt
authors.affiliation: Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Boel
authors.affiliation: Department of Surgery, Køge Hospital, Køge, Denmark.
authors.forename: Ismail
authors.initials: I
authors.lastname: Gögenur
mesh_terms: D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D002940:Circadian Rhythm; D002983:Clinical Competence; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D066231:Surgeons
keywords: Clavien-Dindo; Medical Knowledge; Patient Care; Professionalism; acute appendicitis; circadian rhythm; laparoscopy; night shifts; surgeons’ performance