Night-Time Presentation as an Independent Predictor of Unnecessary Appendectomy in Children: A Prospective Cohort Study
In brief
Children admitted at night had 3.5 times the odds of unnecessary appendectomy
In a prospective cohort of 653 children who underwent appendectomy, 53 (8.1%) had a normal appendix. Night-time admission was independently associated with 3.5 times the odds of an unnecessary operation; low inflammatory markers and a negative ultrasound were also associated. The findings identify a context for extra diagnostic caution, but do not show that night-time care causes avoidable surgery.
- Journal
- World journal of surgery (Q1)
- Published
- 18 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Mohamed Zouari, Oumaima Jarboui, Asma Issaoui, Rim Ouaghleni, Mohamed Karim Tounsi
- PMID
- 42894414
- DOI
- 10.1002/wjs.70640
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 20 October 2026): Prospective cohort identifies night admission risk for unnecessary appendectomy
Abstract
BACKGROUND: Unnecessary appendectomy (UA) remains an important quality indicator in pediatric emergency surgery, reflecting persistent diagnostic uncertainty despite advances in clinical assessment and imaging. The aim of this study was to identify predictors of UA in children. METHOD: This investigation was designed as a prospective cohort study involving consecutive pediatric patients who underwent appendectomy for suspected acute appendicitis during January 2022 through December 2025. Unnecessary appendectomy was defined as the removal of a macroscopically and histologically normal appendix. RESULTS: A total of 653 children were included, of whom 53 (8.1%) underwent UA. The median age was 9.5 years, and males represented 66.8% of the cohort. Univariate analysis identified several factors potentially associated with UA. After adjustment for confounding variables, four factors remained independently associated with UA. These independent predictors included night-time admission (OR 3.51; 95% CI 1.83-6.71; p < 0.001), a NLR below 5 (OR 3.12; 95% CI 1.60-6.12; p = 0.001), a CRP level below 10 mg/L (OR 2.13; 95% CI 1.12-4.06; p = 0.021), and a negative US result (OR 5.67; 95% CI 2.98-10.76; p < 0.001). CONCLUSION: Unnecessary appendectomy in children is influenced not only by clinical and biological variables but also by contextual factors related to the timing of presentation. Recognition of night-time admission as a high-risk context may support more cautious decision-making strategies and help reduce avoidable surgical interventions in pediatric emergency care.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.