Management of Uncomplicated Acute Appendicitis as Day Case Surgery: Feasibility and a Critical Analysis of Exclusion Criteria and Treatment Failure

Grelpois, Gérard; Sabbagh, Charles; Cossé, Cyril; Robert, B.; Chapuis-Roux, E.; Ntouba, Alexandre; Lion, T.; Régimbeau, Jean-Marc

doi:10.1016/j.jamcollsurg.2016.08.004

Cited by 15 publications

(16 citation statements)

References 26 publications

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“…In this series, 59% of all appendectomies were performed as ambulatory procedures, which is higher than the rates reported in studies with a similar definition of AS (Table 4 ), whose IIT population comprised complicated appendicitis [ 6 , 11 , 12 ]. Sabbagh et al [ 12 ], Lefrançois et al [ 6 ], and Grelpois et al [ 11 ] reported ambulatory surgery in 18, 20, and 32% of cases, respectively.…”

Section: Discussionmentioning

confidence: 56%

“…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%

“…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%

“…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: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 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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“…1 Various types of appendicitis are described, ranging from noncomplicated appendicitis to fecal peritonitis. 2 Definition of the type of appendicitis (based on the appearance of the appendix and peritoneum) is important, as it determines the type of preoperative management (ambulatory surgery or immediate surgery), [3][4][5] intraoperative management (aspiration, lavage) and subsequent management (hospitalization, postoperative antibiotic therapy). The type of appendicitis also has a direct impact on postoperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study

Mariage¹,

Sabbagh²,

Grelpois³

et al. 2019

Euroasian Journal of Hepato-Gastroenterology

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Aim: Definition of the type of appendicitis is based on examination of the peritoneum and appendix. Gomes et al. proposed a laparoscopic grading system of acute appendicitis (grades 1 and 2, noncomplicated appendicitis, grade 3-5 complicated appendicitis). The aim of this study was to evaluate the reproducibility of this score. Patients and methods: All patients managed for acute appendicitis between January 2016 and June 2016 were included in this singlecenter prospective study. Laparoscopic appendectomy procedures were filmed by analogy to Sugerbaker's peritoneal carcinomatosis score (9 quadrants, all of the abdomen was filmed). The videos were then analyzed by seven staff surgeons blinded to each other and the operative report. The primary endpoint was to determine the concordance between staff surgeons for grading of appendicitis using the laparoscopic grading system of acute appendicitis described by Gomes et al. Results:A total of 40 patients were included in this study. A concordance was observed between the seven staff surgeons in 85% of cases. For regional peritonitis, the mean ± (SD) number of quadrants in which the staff surgeons reported signs of peritonitis was 1.44 ± 0.63. For diffuse peritonitis, the mean (SD) number of quadrants in which the staff surgeons reported signs of peritonitis was 2.59 ± 0.51. On ROC curve analysis, two quadrants was the best cut-off between grade 4B (local peritonitis) and five (diffuse peritonitis) acute appendicitis (AUC = 0.92, Se = 100%, Sp = 92%, p = 0.005). Conclusion:The classification used to determine the type of appendicitis is reproducible. Clinical significance: To give a definition of complicated appendicitis.

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Effect of Time to Operation on Value of Care in Acute Care Surgery

et al. 2018

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Management of Uncomplicated Acute Appendicitis as Day Case Surgery: Feasibility and a Critical Analysis of Exclusion Criteria and Treatment Failure

Cited by 15 publications

References 26 publications

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study

Effect of Time to Operation on Value of Care in Acute Care Surgery

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