Aleix Martínez-Pérez1, Carmen Payá-Llorente2, Sandra Santarrufina-Martínez3, Juan Carlos Sebastián-Tomás2, Elías Martínez-López2, Nicola de'Angelis4. 1. Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar 90, 46017, Valencia, Spain. aleix.martinez.perez@gmail.com. 2. Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar 90, 46017, Valencia, Spain. 3. Department of General and Digestive Surgery, Hospital Universitario de Marqués de Valdecilla, Santander, Spain. 4. Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri-Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France.
Abstract
BACKGROUND: Appendicitis-related hospitalizations linked with peritonitis or postoperative complications result in longer lengths of stay and higher costs. The aim of the present study was to assess the independent association between potential predictors and prolonged hospitalization after laparoscopic appendectomy (LA) for complicated acute appendicitis (CAA). METHODS: A retrospective cohort study was conducted on adult patients diagnosed with CAA in which LA was attempted. The primary outcome was a prolonged length of stay (LOS) after surgery, defined as hospitalizations longer than or equal to the 75th percentile for LOS, including the day of discharge. Hierarchical regression models were run to elucidate the independent predictors for the variable of interest. RESULTS: The present study involved 160 patients with a mean age of 50.71 years. The conversion rate was 1.9%, and the overall postoperative morbidity rate was 23.8%. The median length of stay (LOS) was 5 days (75th percentile: 7 days). Multivariate analyses included nine variables that are statistically and/or clinically relevant to assess its relationship with a prolonged LOS: three preoperative (age, sex, and comorbidity), four intraoperative (appendix gangrene, perforation, degree of peritonitis, and drain placement), and two postoperative (immediate ICU admission and complications). The development of postoperative complications (OR 6.162, 95% CI 2.451-15.493; p = 0.000) and the placement of an abdominal drain (OR 3.438, 95% CI 1.107-10.683; p = 0.033) were found to be independent predictors for prolonged LOS. For patients not presenting postoperative complications, drain placement was the only independent predictor for the outcome (OR 7.853, 95% CI 1.520-40.558; p = 0.014). Sensitivity analyses showed confirmatory results. CONCLUSION: The intraoperative process of care has a clear impact on LOS after LA for CAA in adults; therefore, the decision of whether to drain in these situations should be made more restrictively yet with judicious caution.
BACKGROUND:Appendicitis-related hospitalizations linked with peritonitis or postoperative complications result in longer lengths of stay and higher costs. The aim of the present study was to assess the independent association between potential predictors and prolonged hospitalization after laparoscopic appendectomy (LA) for complicated acute appendicitis (CAA). METHODS: A retrospective cohort study was conducted on adult patients diagnosed with CAA in which LA was attempted. The primary outcome was a prolonged length of stay (LOS) after surgery, defined as hospitalizations longer than or equal to the 75th percentile for LOS, including the day of discharge. Hierarchical regression models were run to elucidate the independent predictors for the variable of interest. RESULTS: The present study involved 160 patients with a mean age of 50.71 years. The conversion rate was 1.9%, and the overall postoperative morbidity rate was 23.8%. The median length of stay (LOS) was 5 days (75th percentile: 7 days). Multivariate analyses included nine variables that are statistically and/or clinically relevant to assess its relationship with a prolonged LOS: three preoperative (age, sex, and comorbidity), four intraoperative (appendix gangrene, perforation, degree of peritonitis, and drain placement), and two postoperative (immediate ICU admission and complications). The development of postoperative complications (OR 6.162, 95% CI 2.451-15.493; p = 0.000) and the placement of an abdominal drain (OR 3.438, 95% CI 1.107-10.683; p = 0.033) were found to be independent predictors for prolonged LOS. For patients not presenting postoperative complications, drain placement was the only independent predictor for the outcome (OR 7.853, 95% CI 1.520-40.558; p = 0.014). Sensitivity analyses showed confirmatory results. CONCLUSION: The intraoperative process of care has a clear impact on LOS after LA for CAA in adults; therefore, the decision of whether to drain in these situations should be made more restrictively yet with judicious caution.
Authors: Mollie Ferris; Samuel Quan; Belle S Kaplan; Natalie Molodecky; Chad G Ball; Greg W Chernoff; Nij Bhala; Subrata Ghosh; Elijah Dixon; Siew Ng; Gilaad G Kaplan Journal: Ann Surg Date: 2017-08 Impact factor: 12.969
Authors: Anna Lasek; Michał Pędziwiatr; Michał Wysocki; Judene Mavrikis; Piotr Myśliwiec; Tomasz Stefura; Maciej Bobowicz; Piotr Major; Mateusz Rubinkiewicz Journal: Wideochir Inne Tech Maloinwazyjne Date: 2018-07-24 Impact factor: 1.195
Authors: J Cueto; B D'Allemagne; J A Vázquez-Frias; S Gomez; F Delgado; L Trullenque; R Fajardo; S Valencia; L Poggi; J Ballí; J Diaz; R González; J H Mansur; M E Franklin Journal: Surg Endosc Date: 2006-03-16 Impact factor: 3.453
Authors: Thomas Jaschinski; Christoph G Mosch; Michaela Eikermann; Edmund Am Neugebauer; Stefan Sauerland Journal: Cochrane Database Syst Rev Date: 2018-11-28
Authors: Salomone Di Saverio; Kostantinos Stasinos; Weronyka Stupalkowska; Umberto Bracale; Pierpaolo Sileri; Antonio Giuliani; Giuseppe Nigri; Efstratios Kouroumpas; James M D Wheeler; Giovanni Domenico Tebala; Francesco Di Marzo; Belinda De Simone; Carlos Pastor Idoate; Nicola De Angelis; Roberto Cirocchi; Patricia Tejedor Journal: Langenbecks Arch Surg Date: 2021-07-16 Impact factor: 2.895