Outpatient Appendectomy in an Emergency Outpatient Surgery Unit 24 h a Day: An Intention-to-Treat Analysis of 194 Patients
- 368 Downloads
To evaluate the feasibility and outcomes of patients operated on for uncomplicated acute appendicitis (UAA) in our 24-h emergency outpatient surgery unit.
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.
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%).
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.
KeywordsEmergency Department Appendicitis Acute Appendicitis Laparoscopic Appendectomy Pelvic Abscess
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.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no competing interests.
- 11.Société française d’anesthésie et de réanimation. Recommandations formalisées d’expert. Prise en charge anesthésique des patients en hospitalisation en ambulatoire. (2009). http://sfar.org/wp-content/uploads/2015/10/2_AFAR_Prise-en-charge-anesthesique-des-patients-en-hospitalisation-ambulatoire.pdf. Accessed March 1, 2016
- 13.Ramesh S, Galland RB (1993) Early discharge from hospital after open appendicectomy. Can J Surg 80:1192–1193Google Scholar
- 23.Cash CL, Frazee RC, Abernathy SW et al (2012) A prospective treatment protocol for outpatient laparoscopic appendectomy for acute appendicitis. J Am Coll Surg 215:101–105; discussion 105–106Google Scholar
- 26.Frazee RC, Abernathy SW, Davis M et al (2014) Outpatient laparoscopic appendectomy should be the standard of care for uncomplicated appendicitis. J Trauma Acute Care Surg 76:79–82; discussion 82–73Google Scholar