Same-Day Discharge in Laparoscopic Acute Non-Perforated Appendectomy

Scott, Andrew; Shekherdimian, Shant; Rouch, Joshua D.; Sacks, Greg D.; Lui, Wendy Y.; Bridges, Letitia T; Heisler, Tracy; Crain, Steven R.; Cheung, Mang King; Aboulian, Armen

doi:10.1016/j.jamcollsurg.2016.10.026

Cited by 41 publications

(32 citation statements)

References 13 publications

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“…In our series, 18% of appendectomies could not be performed in ambulatory settings because they were diagnosed or operated outside standard working hours. This was also observed by Scott et al [ 16 ] who demonstrated that surgeries completed after 8pm had 70% greater odds of retaining the patient overnight.…”

Section: Discussionsupporting

confidence: 75%

“…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%

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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: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Gignoux¹,

Blanchet²,

Lanz³

et al. 2018

World J Emerg Surg

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“…While adult patients with non-perforated appendicitis can be safely discharged on the same day after laparoscopic appendectomy without high rates of complications [12], IBD patients in general have higher complexity, increased hospital costs and health resource utilization [13]. The study findings are similar to published data on IBD patients undergoing elective colectomy for colorectal cancer or diverticular disease where they contribute to higher healthcare resource utilization including prolonged hospitalization and higher hospital costs when compared with non-IBD patients [14].…”

Section: Discussionsupporting

confidence: 77%

Appendectomy for Appendicitis Has Worse Hospital Outcomes in Inflammatory Bowel Disease Patients

Pavurala¹,

Johnson²,

Hinton³

et al. 2018

JBM

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Background and Aims: Appendectomy is the choice of surgery for appendicitis but little is known about its outcomes in patients with Inflammatory Bowel Disease (IBD). We sought to compare hospital outcomes of appendectomy for appendicitis between patients with and without IBD. Methods: This is a cross-sectional study utilizing the Nationwide Inpatient Sample between 2009 and 2013. Patients with appendicitis undergoing appendectomy were identified using appropriate International Classification of Diseases codes. Primary outcomes of interest included length of stay (LOS), hospital costs, and post-surgical complications. Univariate and multivariate analyses were used to compare these outcomes between patients with and without IBD. Results: A total of 849,312 patients with appendicitis undergoing appendectomy were included in this study, of which 4261 patients had IBD. IBD patients had longer LOS and increased hospital costs. Crohn's disease (CD) patients were more likely to develop post-operative pulmonary embolism (adjusted odds ratio (aOR) 7.06, 95% Confidence Interval (CI) (2.19, 22.79)) and anemia (aOR 2.23, 95% CI (1.21, 4.10)), whereas ulcerative colitis patients were more likely to develop post-operative deep vein thrombosis (aOR 9.79, 95% CI (2.41, 39.75)). CD patients were more likely to have perforated appendicitis (aOR 1.37, 95% CI (1.67, 1.11)) and open appendectomy (aOR 1.56, 95% CI (1.96, 1.27)). Conclusions: Appendectomy for appendicitis in IBD patients is associated with adverse hospital outcomes. Focused attempts are needed to decrease the risk of DVT and PE in these patients. Treating patient's pre-surgical anemia and proactive venous thromboembolism prophylaxis in IBD patients How to cite this paper:

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“…In the USA, outpatient LA protocols are currently applied at multiple institutions with the aim to reduce the length of stay and decrease overall health care costs for AA. Results from these experiences demonstrate that outpatient LA can be performed with a high rate of success, low morbidity, and low readmission rate in the case of non-perforated AA [150]. In the study by Frazee et al, 484 patients with uncomplicated AA were managed as outpatients.…”

Section: Q44: Does Laparoscopic Single-incision Surgery Confer Any mentioning

confidence: 99%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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Same-Day Discharge in Laparoscopic Acute Non-Perforated Appendectomy

Cited by 41 publications

References 13 publications

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Appendectomy for Appendicitis Has Worse Hospital Outcomes in Inflammatory Bowel Disease Patients

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

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