Laparoscopic appendectomy for acute appendicitis: a safe same-day surgery procedure?

Over 250,000 cases of appendicitis occur annually in the United States. The mainstay of treatment is surgical removal with admission. Recently, antibiotic therapy as an alternative has been introduced and the state of Maryland has incentivized 23-hour procedures. We studied patients with appendicitis discharged from the recovery room and those with length of stay (LOS) less than 24 hours. We retrospectively reviewed all appendectomies performed from June 2010 to October 2012 by three general surgeons. We excluded cases that were converted to open, appendectomies performed in the setting of another disease process, and incidental appendectomies. A total of 84 laparoscopic appendectomies were included. Of these, 55 patients had LOS less than 24 hours. Pathology, comorbidities, and readmission were recorded. χ(2) analysis was used for determining statistical significance. Average LOS for all patients was 25 hours with a minimum stay of 2 hours and a maximum stay of 96 hours. For patients discharged in less than 24 hours, there was one readmission and 52 (95%) of these patients had simple appendicitis on pathology. A total of 19 patients (22%) were discharged in less than 7 hours (from the recovery room). Among these patients, there were no readmissions, and 18 (95%) were cases of simple appendicitis (P = 0.4431). There was no significant difference in complications or readmission between patients discharged in less than 24 hours and those who stayed longer. Our subgroup analysis indicated that discharge from the postanesthesia care unit after uncomplicated laparoscopic appendectomy should be further evaluated.