OBJECTIVE: Establish a protocol of management of acute appendicitis (AA) in ambulatory surgery (AmbSurg) on the basis of preoperative criteria. BACKGROUND: Ambulatory laparoscopic appendectomy (LA) for AA has not been yet reported. METHODS: All patients who underwent LA between 2010 and 2012 were reviewed. A multivariate analysis was performed to create a predictive score of discharge within the first 24 hours. The score was prospectively used on every AA from January 1, 2013, to December 15, 2013. All patients with 5 or 4 points were proposed for AmbSurg. RESULTS: A total of 468 patients were included retrospectively, 181(38.7%) were discharged within the first 24 hours. In multivariate analysis, predictive factors of early discharge were body mass index less than 28 kg/m, white cell count less than 15,000/mL, C-reactive protein less than 30 mg/L, no radiological signs of perforation, and appendix diameter of 10 mm or smaller. Rate of discharge at day 1 was 72%, 45%, 39%, 21%, 0%, and 0% according to the score 5 to 0 (P < 0.0001). Prospectively, 184 patients had AA and 103 (56%) had a score of 4 or 5. Thirty-eight underwent ambulatory LA [16 (42%) patients were postponed to the next day and went back home]. All patients were directly discharged from recovery room, except 1 (2.6%) patient, after a mean hospital stay of 8.4 hours ± 6.9 hours. A total of 146 patients underwent LA in conventional surgery and 58% were discharged at day 1. Rate of early discharge was significantly associated with the score ranging from 0% to 92% for a score 0 or 5, validating prospectively the score (P < 0.0001). CONCLUSIONS: 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%.
OBJECTIVE: Establish a protocol of management of acute appendicitis (AA) in ambulatory surgery (AmbSurg) on the basis of preoperative criteria. BACKGROUND: Ambulatory laparoscopic appendectomy (LA) for AA has not been yet reported. METHODS: All patients who underwent LA between 2010 and 2012 were reviewed. A multivariate analysis was performed to create a predictive score of discharge within the first 24 hours. The score was prospectively used on every AA from January 1, 2013, to December 15, 2013. All patients with 5 or 4 points were proposed for AmbSurg. RESULTS: A total of 468 patients were included retrospectively, 181(38.7%) were discharged within the first 24 hours. In multivariate analysis, predictive factors of early discharge were body mass index less than 28 kg/m, white cell count less than 15,000/mL, C-reactive protein less than 30 mg/L, no radiological signs of perforation, and appendix diameter of 10 mm or smaller. Rate of discharge at day 1 was 72%, 45%, 39%, 21%, 0%, and 0% according to the score 5 to 0 (P < 0.0001). Prospectively, 184 patients had AA and 103 (56%) had a score of 4 or 5. Thirty-eight underwent ambulatory LA [16 (42%) patients were postponed to the next day and went back home]. All patients were directly discharged from recovery room, except 1 (2.6%) patient, after a mean hospital stay of 8.4 hours ± 6.9 hours. A total of 146 patients underwent LA in conventional surgery and 58% were discharged at day 1. Rate of early discharge was significantly associated with the score ranging from 0% to 92% for a score 0 or 5, validating prospectively the score (P < 0.0001). CONCLUSIONS: 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%.
Authors: David A Talan; Gregory J Moran; Anusha Krishnadasan; Sarah E Monsell; Brett A Faine; Lisandra Uribe; Amy H Kaji; Daniel A DeUgarte; Wesley H Self; Nathan I Shapiro; Joseph Cuschieri; Jacob Glaser; Pauline K Park; Thea P Price; Nicole Siparsky; Sabrina E Sanchez; David A Machado-Aranda; Jesse Victory; Patricia Ayoung-Chee; William Chiang; Joshua Corsa; Heather L Evans; Lisa Ferrigno; Luis Garcia; Quinton Hatch; Marc D Horton; Jeffrey Johnson; Alan Jones; Lillian S Kao; Anton Kelly; Daniel Kim; Matthew E Kutcher; Mike K Liang; Nima Maghami; Karen McGrane; Elizaveta Minko; Cassandra Mohr; Miriam Neufeld; Joe H Patton; Colin Rog; Amy Rushing; Amber K Sabbatini; Matthew Salzberg; Callie M Thompson; Aleksandr Tichter; Jon Wisler; Bonnie Bizzell; Erin Fannon; Sarah O Lawrence; Emily C Voldal; Danielle C Lavallee; Bryan A Comstock; Patrick J Heagerty; Giana H Davidson; David R Flum; Larry G Kessler Journal: JAMA Netw Open Date: 2022-07-01
Authors: Elisabeth M L de Wijkerslooth; Jay M Bakas; Joost van Rosmalen; Anne Loes van den Boom; Bas P L Wijnhoven Journal: Int J Colorectal Dis Date: 2021-02-11 Impact factor: 2.571