Management of Acute Appendicitis in Ambulatory Surgery

Lefrançois, Magalie; Lefèvre, Jérémie H.; Chafaı̈, Najim; Pitel, Sophie; Kerger, Laure; Agostini, Julie; Canard, G.; Tiret, Emmanuel

doi:10.1097/sla.0000000000000795

Cited by 54 publications

(76 citation statements)

References 15 publications

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“…Although it seems logical to calculate length of stay from the time of hospital admission [ 8 , 13 , 15 , 18 ], many authors calculate it from the end of surgery [ 6 , 12 , 13 , 15 , 17 , 18 ]. Over the last decade, definitions of AS changed from day-case surgery with possible overnight stay [ 17 ] to a procedure with no overnight stay [ 6 , 11 , 12 , 16 ]. We followed the current guidelines of the IAAS and defined ambulatory surgery as ‘a procedure where the patient is discharged on the same working day.’…”

Section: Discussionmentioning

confidence: 99%

“…Despite the promotion of antibiotic therapy as a non-invasive alternative, laparoscopic appendectomy remains the standard treatment for acute appendicitis [ 3 – 5 ]. It is a common surgery, performed mostly in young healthy patients, with standardized management, operating time under 1 h, low morbidity, and low average length of hospital stay, all of which render it safe to perform in ambulatory settings [ 6 ]. Over the past decades, appendectomy has been increasingly performed as ‘short stay’ (< 24 h hospital stay) [ 7 – 10 ] or ‘ambulatory’ (no overnight hospital stay) [ 6 , 11 , 12 ] procedures, with satisfactory outcomes and low complication rates [ 13 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is a common surgery, performed mostly in young healthy patients, with standardized management, operating time under 1 h, low morbidity, and low average length of hospital stay, all of which render it safe to perform in ambulatory settings [ 6 ]. Over the past decades, appendectomy has been increasingly performed as ‘short stay’ (< 24 h hospital stay) [ 7 – 10 ] or ‘ambulatory’ (no overnight hospital stay) [ 6 , 11 , 12 ] procedures, with satisfactory outcomes and low complication rates [ 13 – 16 ]. Yet, conventional hospitalization (with overnight stay) remains the routine procedure for acute appendicitis [ 6 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…There is no present consensus on the selection of patients with acute appendicitis for ambulatory surgery (AS). Recently, Lefrançois et al [ 6 ] proposed a new score, which classifies patients into 6 risk levels, to select patients for ambulatory appendectomy without compromising outcomes. In their series, only 20% were discharged on the same day of surgery.…”

Section: Introductionmentioning

confidence: 99%

“…In their series, only 20% were discharged on the same day of surgery. The percentage of appendectomy procedures performed in ambulatory settings reported in the literature varies greatly (20–88%) [ 6 , 8 , 11 – 13 , 15 – 18 ], likely due to inconsistent definitions of AS and to different criteria for enrollment of ambulatory patients.…”

Section: Introductionmentioning

confidence: 99%

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Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Gignoux¹,

Blanchet²,

Lanz³

et al. 2018

World J Emerg Surg

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BackgroundAppendectomy 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.MethodsThe 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).ResultsFrom 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).ConclusionsAmbulatory 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Gignoux¹,

Blanchet²,

Lanz³

et al. 2018

World J Emerg Surg

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Analysis of Outcomes Associated With Outpatient Management of Nonoperatively Treated Patients With Appendicitis

et al. 2022

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IMPORTANCEIn the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial, which found antibiotics to be noninferior, approximately half of participants randomized to receive antibiotics had outpatient management with hospital discharge within 24 hours. If outpatient management is safe, it could increase convenience and decrease health care use and costs. OBJECTIVE To assess the use and safety of outpatient management of acute appendicitis. DESIGN, SETTING, AND PARTICIPANTS This cohort study, which is a secondary analysis of the CODA trial, included 776 adults with imaging-confirmed appendicitis who received antibiotics at 25

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Auswirkungen der ersten COVID‑19-Welle auf die Viszeralchirurgie

Steffani

Merz

Stöß

et al. 2021

Chirurg

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Zusammenfassung Hintergrund Während der ersten COVID-19-Pandemiewelle führte die Aussetzung aller elektiven Eingriffe im Zeitraum vom 15.03. bis 15.05.2020 in Deutschland zu einem Rückgang an Operationen. Die Auswirkungen auf die Zahl spezifischer Operationen in der Viszeralchirurgie sind bislang nicht bekannt. Methoden In diese retrospektive Studie wurden 301 Patienten eingeschlossen, die eine Cholezystektomie bzw. Appendektomie an einem Universitätsklinikum oder Krankenhaus der Grund- und Regelversorgung zwischen dem 15.03.2020 und 05.05.2020 (vs. 2018 und 2019) erhielten. Analysiert wurden die Fallzahlen und der klinische Verlauf. Ergebnisse Die Aussetzung des Elektivprogramms führte zu einer signifikanten Reduktion elektiver Cholezystektomien und notfallmäßiger Appendektomien. Am Universitätsklinikum reduzierte sich die Anzahl der Appendektomien von 24 im Jahr 2018 um 33 % auf 16 im Jahr 2020, die Zahl der Cholezystektomien sank von 30 um 57 % auf 13. Am Grundversorger reduzierte sich die Zahl der Appendektomiepatienten von 23 im Jahr 2018 um 48 % auf 12 im Jahr 2020, die Zahl der Cholezystektomien stieg im Jahr 2018 auf 2019 an und sank anschließend um 30 % im Jahr 2020. Die Operationsdauer, Krankenhausverweildauer und der klinische Verlauf der Patienten unterschied sich nicht signifikant zu den Vorjahreszeiträumen. Diskussion Der Lockdown während der ersten COVID-19-Pandemiewelle führte zu einer deutlichen Reduktion häufiger viszeralchirurgischer Eingriffe. Um die medizinische Versorgung der gesamten Bevölkerung während einer Pandemie möglichst auf hohem Niveau zu erhalten, müssen aktuelle Möglichkeiten der operativen und konservativen Therapie, unter anderem abhängig von lokalen Infektionszahlen und den individuellen Komorbiditäten der Patienten, gegeneinander abgewogen werden.

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Management of Acute Appendicitis in Ambulatory Surgery

Abstract: We establish a simple validated predictive score of early discharge. When applied to AmbSurg, it allowed us to select patients eligible with a success rate of 97%.

Cited by 54 publications

References 15 publications

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Analysis of Outcomes Associated With Outpatient Management of Nonoperatively Treated Patients With Appendicitis

Auswirkungen der ersten COVID‑19-Welle auf die Viszeralchirurgie

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