Impact on Early Discharge After Emergency Department-Based Treatment Pathway in Nonperforated Appendicitis: A Retrospective Study

Abstract

Background Acute appendicitis is a global disease and a very common indication for emergency surgery worldwide. The need for hospital resources is therefore constantly high. The administration in Kanta-Häme Central Hospital, southern Finland, called for an urgent reorganisation due to shortage of hospital beds at the department of general surgery. Treatment pathway of nonperforated acute appendicitis was moved into Emergency Department (ED). The aim of this study was to assess whether it affected the length of in-hospital stay (LOS) and the 30-day complication rate.MethodsThis is a retrospective pre- and post- intervention analysis. After the reorganisation, most postoperative patients with nonperforated appendicitis were followed at the 24-hour observation unit of the ED instead of the surgical ward. Patients operated during the first three months after the reorganisation were compared to those operated during the three months before it. A case met inclusion criteria if there were no signs of appendiceal perforation during surgery. Exclusion criteria comprised age <18 years and perforated disease. ResultsDuring the study period, appendicectomy was performed on 112 patients, of whom 62 were adults with nonperforated appendicitis. Twenty-seven of the included patients were treated before the reorganisation, and 35 after it. Twenty of the latter were followed only at the ED. LOS decreased significantly after the reorganisation. Median postoperative time till discharge was 15.67 hrs for all patients after the reorganisation and 13.13 hrs for those exclusively followed at the ED, compared to 24.42 hrs before the reorganisation (standard error 6.2 hrs, 95% confidence interval 2.3–15.2 hrs, p < 0.01). There were no more complications in the group treated postoperatively in the ED. ConclusionsEarly discharge from the ED observation unit after appendicectomy for nonperforated appendicitis in adults is safe and feasible. Shifting the postoperative monitoring and the discharge policy of such patients to the ED – instead of the surgical ward – occurred in the majority of the cases after the reorganisation. This change may spare resources as in this series it resulted in a significantly shorter LOS without any increase in the 30-day complication rate.