Reconsideraton of acute appendicitis treatment strategy from the perspective of Work Style Reform

Abstract

Background: Work Style Reform has been implemented since April 2024. Previously, our hospital primarily conducted emergency surgery ［operative management （OM）］ for acute appendicitis （AA）. However, nonoperative management （NOM） is also recommended in international guidelines. New treatment strategy for AA: Beginning in April 2023, our hospital included cases of AA with appendicoliths or peritonitis among the indications for OM. Materials and method: We reviewed OM cases for AA at our hospital from 2019 to 2022 （first term） and in 2023 （second term）. We analyzed the number of OM cases, the timing of surgeries, and the safety of the strategy. Results: In the first term, 381 cases were reviewed, with 48.5% having NOM indications in accordance with the new treatment strategy, and 75.5% of surgeries were performed after hours. In the second term, there were 58 OM cases, with 14 conducted during the night shift, reflecting a 69.8% decrease. Additionally, 15 of 135 NOM cases were switched to OM because of non-response. Conclusion: Implementing NOM for AA may help to reduce overtime work among surgeons.