Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Abstract

BackgroundAppendectomy is increasingly performed as a ‘short stay’ or ‘ambulatory’ procedure, yet there is no consensus for selection of patients with acute appendicitis for ambulatory surgery (AS). We aimed to compare characteristics and outcomes of complicated and uncomplicated appendectomies performed in ambulatory vs. conventional settings, and to determine factors associated with unexpected re-consultations and re-hospitalizations.MethodsThe authors reviewed a consecutive series of 185 laparoscopic appendectomies. Whenever possible, patients were offered AS, defined as ‘discharge on the same working day.’ Multivariable regressions were performed to determine associations of unexpected re-consultations and re-hospitalizations with surgery type (ambulatory or conventional) and patient characteristics (age, gender, obesity, symptoms, appendicolith, perforations, appendix diameter, serologic results, American Society of Anesthesiologists score, and Saint-Antoine score).ResultsFrom the initial cohort, 117 patients (63.2%) were eligible for AS, of which 8 had peri- or post-operative contraindications. Therefore, 109 patients (58.9%) were operated by AS, with median length of stay 8.5 h (range, 3.3–20.5). Ambulatory cases had a lower incidence of complications (11.9%) than conventional cases (25.0%) (p = 0.029). Uni- and multi-variable regressions revealed that unexpected re-consultations were not significantly associated with any of the pre- or peri-operative variables but that unexpected re-hospitalizations were 4 times more likely for patients with appendicolith (OR, 4.32; p = 0.04).ConclusionsAmbulatory surgery could be considered as a standard procedure for both complicated and uncomplicated acute appendicitis. Appendicolith was found to be an independent risk factor for unexpected re-hospitalization and should therefore trigger closer monitoring.

Quality Outcomes in Appendicitis Care: Identifying Opportunities to Improve Care

“…Appendicitis in this study population was predominantly an adult disease, where no infant, below five years of age, had an appendectomy. This is in keeping with other studies, suggesting that appendicitis is currently increasing in older age groups and it is no longer just in the realm of paediatric surgeons [ 18 , 19 , 20 ]. It reflects the increasing complexity of adult emergency general surgery decision making and the need for quality and performance [ 13 , 21 ].…”

Predictors risk factors for acute complex appendicitis pain in patients: Are there gender differences?

“…The prevalence of appendicitis in the current study occurred higher among young age groups 20–39 years old 48.0% among males and 43.4% among females and this confirmative with previous report study in United States age groups 18–39 years old by 55.4%. [ 21 ] The present study revealed that the prevalence of appendicitis is higher among males (62.6%) compared to the females (37.6%), this is consistent with the previously reported appendicitis prevalence by gender in France[ 22 ] (males 57.8% vs females 42.2%). Moreover, the increased risk of male versus female and age <50 versus age > is in line with the recent literature[ 23 ] and confirming our study.…”

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

“…Median LOS in the entire cohort in our study was 3 days, similar to previous reports 19,26 . On the other hand, there are studies reporting LA in uncomplicated acute appendicitis in an ambulatory setting 27–30 . Therefore, to confirm the real prolonged LOS we used 2*75 IQR of the entire cohort (8 days).…”