WTP3.06 The Impact of Out-of-Hours Operating on Appendicectomy Outcomes: A Systematic Review

Aims With increasing demand for surgical services, utilizing healthcare resources is paramount. Theatre access in-hours (IH) is limited but optimizing out-of-hours (OOH) availability more effectively offers an opportunity to deliver more timely unplanned care. Previous guidance recommends only life-or-limb surgery is undertaken OOH, but data also highlights worse outcomes the longer patients wait for urgent surgical intervention so balancing risks and benefits is paramount. Using appendicectomy as a marker operation, this systematic review compared outcomes OOH versus IH. Methods A systematic review was conducted using PubMed, Medline, and EMBASE databases, according to PRISMA guidelines. Inclusion criteria were all primary research studies involving patients over 16 years undergoing appendicectomy. Primary outcome was overall complication rates. Included papers were assessed for bias using ROBINS-I. Results From 1521 screened abstracts, 14 papers were included. Definitions of OOH varied across studies, and outcome heterogeneity precluded meta-analysis. Of these 14 studies, covering a total of 984,127 procedures, 12 (85.7%) studies found no statistically significant difference in complication rates between IH and OOH appendicectomy. However, a large study from Germany (855,694 appendicectomies) did report an increase in pooled complication rates, length of stay, and intensive care admissions in OOH appendicectomies. The overall risk of bias was rated as low or moderate across the included studies. Conclusions Overall data demonstrate that complication and mortality rates for appendicectomies are comparable between IH and OOH operations. These findings underscore the need for further prospective research to standardise definitions, complexity and outcomes of OOH operating to draw more robust conclusion.