[Interval appendectomy as indicated rather than as routine therapy: fewer operations and shorter hospital stays]

Abstract

Objective: To determine whether performing interval appendectomy only as indicated reduces the number of interval appendectomies, morbidity and duration of hospital stay compared with the conventional approach of routine interval appendectomy.

Design: Prospective and comparison with a historical control group.

Methods: In the period May 2000-December 2002 46 patients were prospectively followed after conservative treatment for an appendiceal mass or abscess. Interval appendectomy was performed only as indicated. Study endpoints were the number of patients who were symptom-free at the last outpatient visit and the number ofinterval appendectomies or emergency appendectomies performed for symptoms or acute appendicitis, respectively. Morbidity and duration of hospital stay were compared with a consecutive historical group of patients who had undergone routine interval appendectomy in the period 1994-April 2000.

Results: Appendectomy was avoided in 29 of the 46 patients. The median total admission time was 9 days versus 12 days for patients who had undergone routine interval appendectomy. Three patients in each group had complications.

Conclusion: By performing interval appendectomy only as indicated for persistent pain in the lower right abdomen or emergency appendectomy for acute appendicitis, the number of appendectomies was reduced by 63% and the duration of hospital stay was reduced by 4 days.