When the clock strikes eight: Nighttime admissions and worse outcomes of patients admitted with emergency general surgery conditions.

INTRODUCTION

Evidence on the impact of nighttime admission for emergency general surgery (EGS) in low- and middle-income countries is limited. We evaluated the association between admission timing and inpatient outcomes at a tertiary care center.

METHODS

We analyzed 32,278 adult EGS admissions from 2010 to 2019, categorized as daytime (8:00 a.m.-7:59 p.m.) or nighttime (8:00 p.m.-7:59 a.m.). Inpatient mortality was the primary outcome. Multivariable logistic regression was used to assess adjusted associations.

RESULTS

Nighttime admissions accounted for 42.4% of cases and were more likely to originate from the emergency department. After adjustment, daytime admission was associated with lower inpatient mortality (odds ratio [OR] 0.79, 95% CI 0.68-0.92) and overall complications (OR 0.78, 95% CI 0.74-0.83). Nighttime admissions also had higher rates of sepsis, acute renal failure, pulmonary failure, and septic shock.

CONCLUSION

Nighttime admission is independently associated with worse EGS outcomes, supporting the need for targeted system-level interventions to improve off-hours surgical care.