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World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2018

Open Access 01-12-2018 | Research article

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Authors: Benoit Gignoux, Marie-Cecile Blanchet, Thomas Lanz, Alexandre Vulliez, Mo Saffarini, Hugo Bothorel, Maud Robert, Vincent Frering

Published in: World Journal of Emergency Surgery | Issue 1/2018

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Abstract

Background

Appendectomy 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.

Methods

The 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).

Results

From 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).

Conclusions

Ambulatory 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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Metadata
Title
Should ambulatory appendectomy become the standard treatment for acute appendicitis?
Authors
Benoit Gignoux
Marie-Cecile Blanchet
Thomas Lanz
Alexandre Vulliez
Mo Saffarini
Hugo Bothorel
Maud Robert
Vincent Frering
Publication date
01-12-2018
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2018
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-018-0191-4

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