Outpatient Laparoscopic Appendectomy: Feasible in a Public County Hospital?

Rosen, David R.; Inaba, Kenji; Oh, Paul; Gutierrez, Adam; Strumwasser, Aaron; Biswas, Subarna; Cala, Melody; Ault, Glenn T.

doi:10.1016/j.jamcollsurg.2017.02.004

Cited by 10 publications

(17 citation statements)

References 23 publications

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“…Length of stay—Thirteen studies reported length of stay, as displayed in Table 1 in hours. Mean postoperative length of stay after SDD ranged from 3.1 ± 1.4 [ 36 ] to 9.6 (standard deviation not given) [ 39 ] h. Nine studies tested for significance, all reporting a statistically significant reduction in LOS for SDD compared to control groups [ 7 , 9 , 12 , 30 , 32 , 35 , 36 , 39 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…Treatment satisfaction—Five studies reported treatment satisfaction to some extent [ 7 , 32 , 35 , 39 , 40 ]. Various short, non-validated surveys were used at different postoperative points in time (details in Table S5 , Appendix B).…”

Section: Resultsmentioning

confidence: 99%

“…Characteristics of all comparative studies are shown in Table 1, grouped into three categories according to study design. Five studies compared patients in a prospective SDD protocol to patients from a historical control cohort (with a lower percentage of SDD) [12,[29][30][31][32]. Three multicenter retrospective studies compared SDD to discharge on POD 1 or 2 at the latest [5,15,33].…”

Section: Comparative Studiesmentioning

confidence: 99%

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Same-day discharge after appendectomy for acute appendicitis: a systematic review and meta-analysis

Wijkerslooth

Bakas

Rosmalen

et al. 2021

Int J Colorectal Dis

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Purpose Patients presenting with acute appendicitis are usually hospitalized for a few days for appendectomy and postoperative recovery. Shortening length of stay may reduce costs and improve patient satisfaction. The purpose of this study was to assess the safety of same-day discharge after appendectomy for acute appendicitis. Methods A systematic review was performed according to PRISMA guidelines. A literature search of EMBASE, Ovid MEDLINE, Web of Science, Cochrane Central, and Google Scholar was conducted from inception to April 14, 2020. Two reviewers independently screened the literature and selected studies that addressed discharge on the same calendar day as the appendectomy. Risk of bias was assessed with the ROBINS-I tool. Main outcomes were hospital readmission, complications, and unplanned hospital visits in the postoperative course. A random effects model was used to pool risk ratios for the main outcomes. Results Of the 1912 articles screened, 17 comparative studies and 8 non-comparative studies met the inclusion criteria. Most only included laparoscopic procedure for uncomplicated appendicitis. Most studies were considered at moderate or serious risk of bias. In meta-analysis, same-day discharge (vs. overnight hospitalization) was not associated with increased rates of readmission, complication, and unplanned hospital visits. Non-comparative studies demonstrated low rates of readmission, complications, and unplanned hospital visits after same-day discharge. Conclusion This study suggests that same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis is safe without an increased risk of readmission, complications, or unplanned hospital visits. Hence, same-day discharge may be further encouraged in selected patients. Trial registration PROSPERO registration no. CRD42018115948

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Comparative Studiesmentioning

confidence: 99%

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Same-day discharge after appendectomy for acute appendicitis: a systematic review and meta-analysis

Wijkerslooth

Bakas

Rosmalen

et al. 2021

Int J Colorectal Dis

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“…For example, many patients with acute appendicitis can now be treated and released from hospital in less than 24 hours as long as rapid access to the operating theatre and programmatic fast track are available. 17,18…”

Section: Discussionmentioning

confidence: 99%

A 30-day prospective audit of all inpatient complications following acute care surgery: How well do we really perform?

Ball

Murphy

Verhoeff

et al. 2020

cjs

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Background: Acute care surgery (ACS) and emergency general surgery (EGS) services must provide timely care and intervention for patients who have some of the most challenging needs. Patients treated by ACS services are often critically ill and have both substantial comorbidities and poor physiologic reserve. Despite the widespread implemention of ACS/EGS services across North America, the true postoperative morbidity rates remain largely unknown. Methods:In this prospective study, inpatients at 8 high-volume ACS/EGS centres in geographically diverse locations in Canada who underwent operative interventions were followed for 30 days or until they were discharged. Readmissions during the 30-day window were also captured. Preoperative, intraoperative and postoperative variables were tracked. Standard statistical methodology was employed.Results: A total of 601 ACS/EGS patients were followed for up to 30 inpatient or readmission days after their index emergent operation. Fifty-one percent of patients were female, and the median age was 51 years. They frequently had substantial medical comorbidities (42%) and morbid obesity (15%). The majority of procedures were minimally invasive (66% laparoscopic). Median length of stay was 3.3 days and the early readmission (< 30 d) rate was 6%. Six percent of patients were admitted to the critical care unit. The overall complication and mortality rates were 34% and 2%, respectively. Cholecystitis (31%), appendicitis (21%), bowel obstruction (18%), incarcerated hernia (12%), gastrointestinal hemorrhage (7%) and soft tissue infections (7%) were the most common diagnoses. The morbidity and mortality rates for open surgical procedures were 73% and 5%, respectively. Conclusion:Nontrauma ACS/EGS procedures are associated with a high postoperative morbidity rate. This study will serve as a prospective benchmark for postoperative complications among ACS/EGS patients and subsequent quality improvement across Canada.Contexte : Les services de chirurgie dans les unités de soins actifs (CSA) et de chirurgie générale dans les services d'urgence (CGSU) doivent fournir rapidement des soins et des interventions à des patients dont les besoins sont parmi les plus complexes. En effet, les patients pris en charge par les services de CSA sont souvent gravement malades et présentent des comorbidités sur fond de faible réserve physiologique. Même si les services de CSA/CGSU se sont répandus en Amérique du Nord, les taux réels de morbidité postopératoire demeurent pour une bonne part inconnus.Méthodes : Dans cette étude prospective, on a suivi pendant 30 jours ou jusqu'à leur congé, les patients hospitalisés pour des interventions chirurgicales dans 8 centres de CSA/CGSU achalandés de divers endroits au Canada. On a également tenu compte des réadmissions dans les 30 jours. Les paramètres pré-, per-et postopératoires ont été enregis trés. Une méthodologie statistique standard a été appliquée.

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“…Por la relevancia del texto completo, se seleccionaron 12 documentos, de los cuales se excluyeron 3, dado que se consideró que no se enfocaban en mostrar resultados relevantes de acuerdo con lo requerido en la presente investigación. Finalmente se obtuvieron 9 artículos para ser analizados [9][10][11][12][13][14][15][16][17] .…”

Section: Revisión De La Literaturaunclassified

Beneficios clínicos y de costos de un modelo de estandarización en el manejo de la apendicitis aguda

2021

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Introducción. La apendicitis aguda es la patología quirúrgica más frecuente en Colombia y en el mundo, con un riesgo de presentación del 7-8 % en la población general. El tratamiento de elección es la apendicectomía, la cual puede realizarse por vía convencional o por vía laparoscópica. El objetivo de este estudio fue comparar los desenlaces clínicos y costos de un modelo de estandarización en el manejo de la apendicitis aguda versus la no estandarización. Métodos. Estudio observacional, analítico, para comparar el manejo de atención estandarizado y no estandarizado. Se incluyeron pacientes mayores de 18 años, que ingresaron al servicio de urgencias con diagnóstico de apendicitis aguda en el período de enero de 2016 a diciembre de 2018, y quienes fueron llevados a apendicectomía convencional o laparoscópica en la institución. Resultados. Se incluyeron 1392 pacientes, 591 que cumplieron los criterios del modelo estandarizado y 801 que cumplieron los criterios del modelo no estandarizado. Al comparar los procesos de estandarización y no estandarización, se encontraron diferencias estadísticamente significativas en los resultados crudos de estancia hospitalaria y costos totales. En los estimativos ajustados por variables de confusión no se encontraron diferencias en los costos totales. Discusión. El modelo de estandarización demostró una disminución en los días de hospitalización. No encontró diferencias en términos de costos totales.

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Outpatient Laparoscopic Appendectomy: Feasible in a Public County Hospital?

Cited by 10 publications

References 23 publications

Same-day discharge after appendectomy for acute appendicitis: a systematic review and meta-analysis

Same-day discharge after appendectomy for acute appendicitis: a systematic review and meta-analysis

A 30-day prospective audit of all inpatient complications following acute care surgery: How well do we really perform?

Beneficios clínicos y de costos de un modelo de estandarización en el manejo de la apendicitis aguda

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