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Ann Surg. 2015 Jun;261(6):1167-72. doi: 10.1097/SLA.0000000000000795.

Management of Acute Appendicitis in Ambulatory Surgery: Is It Possible? How to Select Patients?

Author information

1
From the Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, University Paris VI (Pierre and Marie Curie), Paris, France.

Abstract

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%.

PMID:
24950287
DOI:
10.1097/SLA.0000000000000795
[Indexed for MEDLINE]

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