title: Risk and outcomes of 24-h delayed and weekend appendectomies.
abstract: Time interval from hospital admission to operative intervention has been suggested as a crucial risk factor for a number of surgical procedures. In this study, we aim to compare postappendectomy outcomes for operations performed 24 h after admission or on the weekend to within 24 h and weekday operations, respectively.
  
  
  
  A cross-sectional study using the Nationwide Inpatient Sample database, 2004-2009. The study population included patients who underwent appendectomy for acute appendicitis.
  
  
  
  A total of 265,972 records were identified, of which 221,745 (83.4%) patients had appendectomy on the same day of admission, whereas 16.6% had the procedure the following day. Next day operations were more likely to be associated with postoperative complications (OR = 1.26, 95% CI = [1.19-1.33], P < 0.001). A hospital stay of >3 d was also more common for next day interventions (P < 0.001). Appendectomies performed on weekends had a higher risk of complications compared to other days (OR = 1.08, 95% CI = [1.02-1.14], P = 0.005). Teaching and urban hospitals were more likely to perform appendectomies on the day after admission (P < 0.05). Older patients (≥35 years), females, Blacks and Hispanics, and those on Medicaid or Medicare were all at higher risk of next day intervention (P < 0.01 each). The average cost of next day operations was higher compared to same day operations ($9890.11 ± 119.64 versus $8744.57 ± 77.67, P < 0.001).
  
  
  
  Appendectomies performed 1 d after admission or on the weekend are associated with disadvantageous outcomes. Demographic factors, in addition to hospital attributes, place certain subpopulations at higher risk of next day appendectomies.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Al-Qurayshi
authors.affiliation: Department of Pathology, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Abida
authors.initials: A
authors.lastname: Kadi
authors.affiliation: Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Sudesh
authors.initials: S
authors.lastname: Srivastav
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana. Electronic address: ekandil@tulane.edu.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D000328:Adult; D039602:After-Hours Care; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Appendectomy; Delayed intervention; Demographic disparity; Economic disparity; Postoperative complication; Weekend effect