Comparison of anesthesia management in adult patients undergoing appendectomy and caesarean section during the day and night shift

Caesarean sections and appendectomies are the two most frequently performed surgeries at our center, both during regular hours and night shifts. Variations in anesthesia practices between daytime and nighttime surgeries may influence intraoperative and postoperative complications. This study aims to compare the characteristics of caesarean section and appendectomy cases performed during regular working hours and on-call hours, and to identify potential factors associated with perioperative complications. Adult patients who underwent caesarean section (n=132) or appendectomy (n=20) during the day shift (08:00-17:00) or night shift (17:00-08:00) at our center between 01.07.2023 and 01.01.2024 were included in the study. Basic demographic and clinical characteristics of the patients, anesthesia types, intraoperative anesthesia practices, and perioperative complication data were collected prospectively. During working hours, 94.2% of the surgeries were cesarean sections, compared to 71.4% during on-call hours (p<0.001). There was no significant difference between surgery times concerning prophylactic antibiotic use (p=0.243), median number of lumbar puncture (p=0.101) or intubation attempts (p=0.943), bupivacaine dose (p=0.705), or fentanyl use (p=0.472). However, the use of antiemetic drugs (p<0.001), spinal or combined anesthesia (p=0.005), and intraoperative fluid administration exceeding 1000 mL (p=0.01) were significantly higher during daytime surgeries compared to on-call surgeries. The need for intraoperative vasopressors was more common during working hours (p=0.001), while the incidence of postoperative nausea or vomiting was higher after on-call operations (p=0.013). Intraoperative vasopressor use was associated with the absence of a heater during surgery; intraoperative headache with shorter patient height; postoperative low back pain with an increased number of lumbar puncture attempts; and postoperative urinary retention with the presence of endocrinological disease. Although univariate analysis indicated that male gender, undergoing appendectomy, not using antiemetic drugs, general anesthesia, and total intraoperative fluid administration below 1000 mL were risk factors for postoperative nausea or vomiting, multivariate analysis revealed that none of these were independent risk factors.