Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes. To perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed (2), time elapsed from symptom onset to hospital presentation (patient time) (3), time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes. A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into < 24 h, 24–48 h and > 48 h. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed. Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were < 24 h. Readmission and mortality rates were significantly better when the hospital time was < 48 h. SSI, operative time, and the rate of perforation were comparable in all groups. Appendicectomy within 24 h of hospital admission is associated with improved outcomes compared to patients having surgery 24–48 and > 48 h after admission. The time-of-day which surgery is performed does not impact outcomes.

中文翻译：

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阑尾切除术时机对结果的影响：系统评价和网络荟萃分析


阑尾切除术仍然是阑尾炎的标准治疗方法。为避免不良后果而进行手术的时间表尚不明确。进行系统回顾和网络荟萃分析，以评估 (1) 进行手术的时间 (2)、从症状出现到入院所经过的时间（患者时间）(3)、从医院起所经过的时间接受手术的时间（住院时间）和（4）从症状出现到手术的时间（总时间）都会影响阑尾切除术的结果。根据 PRISMA-NMA 指南进行了系统评价。一天中进行手术的时间分为白天、傍晚和夜间。其他组分为<24小时、24-48小时和>48小时。分析复杂性阑尾炎发生率、手术时间、穿孔、术后并发症、手术部位感染（SSI）、住院时间（LOS）、再入院率和死亡率。纳入 16 项研究，总共 232,678 名患者。一天中进行手术的时间对结果没有影响。当住院时间和总时间<24小时时，复杂性阑尾炎、术后并发症和LOS的发生率明显更好。当住院时间 < 48 小时时，再入院率和死亡率显着降低。所有组的 SSI、手术时间和穿孔率相当。与入院后 24-48 小时和 > 48 小时内进行手术的患者相比，入院 24 小时内进行阑尾切除术可改善预后。进行手术的时间不会影响结果。