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. 2018 Jun 28:13:28.
doi: 10.1186/s13017-018-0191-4. eCollection 2018.

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Benoit Gignoux  1 , Marie-Cecile Blanchet  1 , Thomas Lanz  2 , Alexandre Vulliez  2 , Mo Saffarini  3 , Hugo Bothorel  3 , Maud Robert  4 , Vincent Frering  1
Affiliations

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Benoit Gignoux et al. World J Emerg Surg. .

Abstract

Background: Appendectomy 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.

Methods: The 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).

Results: From 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).

Conclusions: Ambulatory 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.

Keywords: Ambulatory surgery; Appendicolith; Complicated appendicitis; Conventional hospitalization; Laparascopic appendectomy.

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Conflict of interest statement

Data was collected as part of routine post-operative follow-up, and all patients provided informed consent for the use of their data for research purposes. The institutional review board approval was therefore not required for this study.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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