Aurélie Vuagniaux1, Olivier Gié1, Fabio Butti1, Pedro Manuel Marques-Vidal2,3, Nicolas Demartines4,5, Styliani Mantziari1,3. 1. Department of Visceral Surgery and Transplantation, Centre Hospitalier Universitaire Vaudois, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. 2. Department of Internal Medicine, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland. 3. Faculty of Biology and Medicine, Lausanne University UNIL, Lausanne, Switzerland. 4. Department of Visceral Surgery and Transplantation, Centre Hospitalier Universitaire Vaudois, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. demartines@chuv.ch. 5. Faculty of Biology and Medicine, Lausanne University UNIL, Lausanne, Switzerland. demartines@chuv.ch.
Abstract
BACKGROUND: Outpatient appendectomy for acute appendicitis is a feasible, yet not widely performed procedure, as there are no universally accepted criteria for patient selection. The aim of this study was to assess preoperative clinical factors associated with successful short-stay appendectomy (SSA) and establish a predictive score to help with patient selection. METHODS: All consecutive laparoscopic appendectomies performed in our institution between January 2013 and June 2015 were retrospectively analyzed. Several preoperative clinical and biological variables were compared between patients with SSA, defined as a postoperative stay <24 h, and those needing inpatient care. Logistic regression analysis was used to identify variables independently associated with SSA, and these variables were then used to create a predictive score. RESULTS: A total of 578 patients were included, 303 (53%) in the SSA group and 275 (48%) in the long-stay appendectomy (LSA) group. In multivariate analysis, male gender (OR 1.61, 95% CI 1.12-2.31, p = 0.010), ASA class I-II (OR 9.52, 95% CI 1.65-180.69, p = 0.037), absence of generalized guarding (OR 3.55, 95% CI 1.30-11.41, p = 0.019), C-reactive protein <100 mg/dl (OR 3.09, 95% CI 1.81-5.42, p < 0.001) and leukocyte count <20 g/l (OR 2.06, 95% CI 1.02-4.30, p = 0.046) were independently associated with SSA. These five parameters were used to construct a predictive score, whereby ≥17 (range 0-21) was defined as the optimal threshold to predict SSA with a high sensitivity (95.6%) and negative predictive value (82.2%). CONCLUSIONS: A purely clinical predictive score based on five widely used preoperative parameters can be used to identify eligible patients for short-stay appendectomy.
BACKGROUND:Outpatient appendectomy for acute appendicitis is a feasible, yet not widely performed procedure, as there are no universally accepted criteria for patient selection. The aim of this study was to assess preoperative clinical factors associated with successful short-stay appendectomy (SSA) and establish a predictive score to help with patient selection. METHODS: All consecutive laparoscopic appendectomies performed in our institution between January 2013 and June 2015 were retrospectively analyzed. Several preoperative clinical and biological variables were compared between patients with SSA, defined as a postoperative stay <24 h, and those needing inpatient care. Logistic regression analysis was used to identify variables independently associated with SSA, and these variables were then used to create a predictive score. RESULTS: A total of 578 patients were included, 303 (53%) in the SSA group and 275 (48%) in the long-stay appendectomy (LSA) group. In multivariate analysis, male gender (OR 1.61, 95% CI 1.12-2.31, p = 0.010), ASA class I-II (OR 9.52, 95% CI 1.65-180.69, p = 0.037), absence of generalized guarding (OR 3.55, 95% CI 1.30-11.41, p = 0.019), C-reactive protein <100 mg/dl (OR 3.09, 95% CI 1.81-5.42, p < 0.001) and leukocyte count <20 g/l (OR 2.06, 95% CI 1.02-4.30, p = 0.046) were independently associated with SSA. These five parameters were used to construct a predictive score, whereby ≥17 (range 0-21) was defined as the optimal threshold to predict SSA with a high sensitivity (95.6%) and negative predictive value (82.2%). CONCLUSIONS: A purely clinical predictive score based on five widely used preoperative parameters can be used to identify eligible patients for short-stay appendectomy.
Authors: Richard C Frazee; Stephen W Abernathy; Claire L Isbell; Travis Isbell; Justin L Regner; Randall D Smith Journal: J Am Coll Surg Date: 2016-01-14 Impact factor: 6.113
Authors: Casandra L Cash; Richard C Frazee; Stephen W Abernathy; Edward W Childs; Matthew L Davis; John C Hendricks; Randall W Smith Journal: J Am Coll Surg Date: 2012-05-19 Impact factor: 6.113
Authors: Benoit Gignoux; Marilyn Gosgnach; Thomas Lanz; Alexandre Vulliez; Marie-Cecile Blanchet; Vincent Frering; Jean-Luc Faucheron; Philippe Chasserant Journal: Ann Surg Date: 2019-08 Impact factor: 12.969