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Preoperative Clinical Factors Associated with Short-Stay Laparoscopic Appendectomy

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Abstract

Background

Outpatient appendectomy for acute appendicitis is a feasible, yet not widely performed procedure, as there are no universally accepted criteria for patient selection. The aim of this study was to assess preoperative clinical factors associated with successful short-stay appendectomy (SSA) and establish a predictive score to help with patient selection.

Methods

All consecutive laparoscopic appendectomies performed in our institution between January 2013 and June 2015 were retrospectively analyzed. Several preoperative clinical and biological variables were compared between patients with SSA, defined as a postoperative stay <24 h, and those needing inpatient care. Logistic regression analysis was used to identify variables independently associated with SSA, and these variables were then used to create a predictive score.

Results

A total of 578 patients were included, 303 (53%) in the SSA group and 275 (48%) in the long-stay appendectomy (LSA) group. In multivariate analysis, male gender (OR 1.61, 95% CI 1.12–2.31, p = 0.010), ASA class I–II (OR 9.52, 95% CI 1.65–180.69, p = 0.037), absence of generalized guarding (OR 3.55, 95% CI 1.30–11.41, p = 0.019), C-reactive protein <100 mg/dl (OR 3.09, 95% CI 1.81–5.42, p < 0.001) and leukocyte count <20 g/l (OR 2.06, 95% CI 1.02–4.30, p = 0.046) were independently associated with SSA. These five parameters were used to construct a predictive score, whereby ≥17 (range 0–21) was defined as the optimal threshold to predict SSA with a high sensitivity (95.6%) and negative predictive value (82.2%).

Conclusions

A purely clinical predictive score based on five widely used preoperative parameters can be used to identify eligible patients for short-stay appendectomy.

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Author information

Author notes

  1. Aurélie Vuagniaux and Olivier Gié have contributed equally.

Authors and Affiliations

  1. Department of Visceral Surgery and Transplantation, Centre Hospitalier Universitaire Vaudois, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Aurélie Vuagniaux, Olivier Gié, Fabio Butti, Nicolas Demartines & Styliani Mantziari

  2. Department of Internal Medicine, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland

    Pedro Manuel Marques-Vidal

  3. Faculty of Biology and Medicine, Lausanne University UNIL, Lausanne, Switzerland

    Pedro Manuel Marques-Vidal, Nicolas Demartines & Styliani Mantziari

Authors
  1. Aurélie Vuagniaux
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  2. Olivier Gié
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  3. Fabio Butti
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  4. Pedro Manuel Marques-Vidal
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  5. Nicolas Demartines
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  6. Styliani Mantziari
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Contributions

OG, AV, SM and ND conducted conception of the study, interpreted the results and drafted the manuscript. AV and FB were involved in data collection, and SM and MVPM performed statistical analysis. ND performed critical editing of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nicolas Demartines.

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Informed general consent was obtained from all participants included in the study.

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Vuagniaux, A., Gié, O., Butti, F. et al. Preoperative Clinical Factors Associated with Short-Stay Laparoscopic Appendectomy. World J Surg 43, 2771–2778 (2019). https://doi.org/10.1007/s00268-019-05115-7

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  • DOI: https://doi.org/10.1007/s00268-019-05115-7

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