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Outpatient Appendectomy in an Emergency Outpatient Surgery Unit 24 h a Day: An Intention-to-Treat Analysis of 194 Patients

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Abstract

Objective

To evaluate the feasibility and outcomes of patients operated on for uncomplicated acute appendicitis (UAA) in our 24-h emergency outpatient surgery unit.

Methods

This was a prospective observational study with intention-to-treat (ITT) analysis. From 12/2013 to 03/2015, all consecutive patients admitted for acute appendicitis (AA) were prospectively screened. A computed tomography or abdominal ultrasound confirmed the diagnosis of AA. Eligibility criteria for outpatient appendectomy were: UAA, no comorbidity, no physical or mental condition preventing participation in the study, absence of pregnancy, age older than 15 years, an accompanying adult person available for the hospital discharge and place of residence within 1 h of our hospital. In the case of intraoperative complication (abscess, local or general peritonitis) or complication of general anesthesia, patients were excluded from the outpatient pathway. The primary endpoint was the feasibility of outpatient appendectomy among all consecutive patients admitted for UAA.

Results

Of the 194 screened patients, 150 (77%) presented an UAA and 102 (68%) were eligible for an outpatient procedure. Thirteen eligible patients (13%) were excluded from the outpatient circuit (7 intraoperative and 6 postoperative contraindications). Outpatient appendectomy was performed in 89 patients, representing 59% (89/150) of the ITT population and 87% (89/102) of the eligible patients. The median length of hospital stay was 13 h. Postoperative complications were observed in six patients (6%).

Conclusions

This study reports a safe and feasible management of UAA. Our organization allows a short hospitalization for postoperative recovery without using conventional surgery beds and enables discharge throughout the night.

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Acknowledgements

We thank Dr. David Baker DM, FRCA, (Emeritus Consultant Anesthesiologist, Department of Anesthesiology and Critical Care, Hôpital Necker-Enfants Malades, Paris) for reviewing the manuscript. Support was provided solely from institutional and/or departmental sources.

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Authors and Affiliations

  1. Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Departments of Emergency Medicine and Surgery, Sorbonne Universités, UPMC University Paris 6, Paris, France

    Adeline Aubry & Bruno Riou

  2. Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Departments of Digestive and Hepato-Pancreato-Biliary Surgery, Sorbonne Universités, UPMC University Paris 6, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Arnaud Saget, Gilles Manceau & Mehdi Karoui

  3. Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Departments of General and Endocrinology Surgery, Sorbonne Universités, UPMC University Paris 6, Paris, France

    Matthieu Faron & Christophe Tresallet

  4. Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Departments of Radiology, Sorbonne Universités, UPMC University Paris 6, Paris, France

    Mathilde Wagner & Olivier Lucidarme

  5. Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Departments of Anesthesiology and Critical Care, Sorbonne Universités, UPMC University Paris 6, Paris, France

    Frédéric le Saché

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  1. Adeline Aubry
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  2. Arnaud Saget
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  10. Mehdi Karoui
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Corresponding author

Correspondence to Mehdi Karoui.

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Aubry, A., Saget, A., Manceau, G. et al. Outpatient Appendectomy in an Emergency Outpatient Surgery Unit 24 h a Day: An Intention-to-Treat Analysis of 194 Patients. World J Surg 41, 2471–2479 (2017). https://doi.org/10.1007/s00268-017-4034-3

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  • DOI: https://doi.org/10.1007/s00268-017-4034-3

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