Outpatient management of appendectomy safe and feasible for patients with uncomplicated appendicitis
Spain: According to a study published in the World Journal of Emergency Surgery, emergency outpatient appendectomy with an Enhanced Recovery After Surgery (ERAS) protocol assured safety and feasibility in non-complicated appendectomy for selected patients. It is achievable with low morbidity, few readmissions, higher satisfaction and reduced cost.
Acute appendicitis (AA) is the most common surgical procedure, with a hazard rate of 1.17 to 1.9 per 1000 habitants per year. It has a lifetime risk of 8.6 % and 6.7 % for men and women, respectively. As mentioned in observational studies, outpatient laparoscopic appendectomy offers feasibility and security in selected patients. The main advantages of the procedure include reduced LOS (length of stay), and complications postoperatively are also reduced.
The information regarding current data states that for selected patients with uncomplicated AA, patients can be treated via an outpatient route. There needs to be more good-quality evidence in this context.
With this background, Jordi Elvira López did a study evaluating the efficacy and safety of this protocol in patients with a history of uncomplicated AA.
The summary of the study points is as follows:
- There were two groups: standard care within the hospital (HG) and outpatient group (OG).
- Patients were admitted from the emergency department with AA and randomized.
- HG patients were admitted to the surgical ward.
- OG patients were admitted to the day-surgery unit.
- Length of stay (LOS) was the primary endpoint.
- The study included 97 patients, 49 in OG and 48 in the HG group.
- In OG, the LOS was significantly shorter, with a mean of 8.82 h, compared to HG, having a mean of 43.53 hours.
- The researchers recorded no difference in readmission rates.
- There was only one readmission in the OG.
- No complications and further emergency consultations were observed in the study.
- As a result of the intervention, the cost saving was $516.52/patient.
To sum it up, Outpatient management of appendectomy is safe and feasible. It may become the standard of care for uncomplicated appendicitis patients as it has fewer complications, lower LOS and cost.
Further reading:
Elvira López, J., Sales Mallafré, R., Padilla Zegarra, E. et al. Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial. World J Emerg Surg 17, 59 (2022). https://doi.org/10.1186/s13017-022-00465-5
