Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy – A Randomized Controlled Trial

Abstract

Objective: To confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an Enhanced Recovery After Surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis. Summary Background Data: Outpatient laparoscopic appendectomy is feasible and secure in selected patients in observational studies. The benefits include reduced length of stay (LOS) and post-operative complications. This is the first Randomized Controlled Trial (RCT) of outpatient management following ERAS protocol. Methods: Patients admitted from the emergency department with acute appendicitis randomized into one of two groups. Standard care within the hospital (HG) or the outpatient group (OG). An ERAS protocol was followed for both groups. Patients in the HG were admitted to the surgical ward. Patients in the OG were referred to the day-surgery unit. The primary endpoint was length of stay. Results: Ninety-seven patients were included, 49 in the OG and 48 in the HG. LOS was significantly shorter in the OG (mean 8.82h) than the HG (mean 43.53h), p<0.001. There was no difference in readmission rates (p = 0.320), we observed only one readmission in the OG. No further emergency consultations or complications were observed. The cost saving was $516.52/patient as a result of the intervention. Conclusion: Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost. Trial registration: Clinical Trial ID: NCT05401188 Keywords: Appendicitis, Acute Appendicitis, uncomplicated Acute Appendicitis, outpatient management, laparoscopic appendectomy, ERAS protocol