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01-07-2021 | Peritonitis

Predictors for prolonged length of stay after laparoscopic appendectomy for complicated acute appendicitis in adults

Authors: Aleix Martínez-Pérez, Carmen Payá-Llorente, Sandra Santarrufina-Martínez, Juan Carlos Sebastián-Tomás, Elías Martínez-López, Nicola de’Angelis

Published in: Surgical Endoscopy | Issue 7/2021

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.

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Title: Predictors for prolonged length of stay after laparoscopic appendectomy for complicated acute appendicitis in adults
Authors: Aleix Martínez-Pérez
Carmen Payá-Llorente
Sandra Santarrufina-Martínez
Juan Carlos Sebastián-Tomás
Elías Martínez-López
Nicola de’Angelis
Publication date: 01-07-2021
Publisher: Springer US
Keywords: Peritonitis
Appendicitis
Appendicitis
Appendectomy
Published in: Surgical Endoscopy / Issue 7/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07841-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictors for prolonged length of stay after laparoscopic appendectomy for complicated acute appendicitis in adults

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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