Virginia Durán Muñoz-Cruzado (Seville / ES), Laura Navarro Morales (Seville / ES), Felipe Pareja Ciuró (Seville / ES), Daniel Aparicio Sánchez (Seville / ES), Eduardo Perea del Pozo (Seville / ES), Isidro Martínez Casas (Seville / ES), Carmen Martín Jiménez (Seville / ES), Javier Padillo Ruiz (Seville / ES)
Abstract text (incl. references and figure legends)
Introduction: Acute appendicitis is the most common cause of surgical acute abdomen in the world. Improvements in the management can represent significant savings for the health system. In recent years, some studies have appeared that propose outpatient surgical management of uncomplicated appendicitis. However, there are currently no works with statistical quality that demonstrate that this strategy is safe, effective and efficient.
Methods: A randomized clinical trial was carried out between October 2018 and June 2021where 761 patients with suspected uncomplicated appendicitis were initially evaluated. 300 patients were finally included and randomized into two groups: 149 patients in the outpatient surgery group and 151 patients in the inpatient surgery group. The percentage of success of the strategy in the outpatient surgery group, the reasons for which the patients were admitted, the complications, reintervention and readmission in both groups were analyzed. A satisfaction questionnaire was administered in both groups. A cost analysis was performed.
Results: 128/149 patients in the outpatient surgery group (85.9%) were discharged without needing to be admitted. Pain, fear, and insecurity were described as predictors of the need for admission in patients assigned to the outpatient surgery group. Both groups had a similar rate of complications, readmissions and reinterventions. Perceived quality was equally similar in both groups. In the cost study, an increase in costs was observed in the inpatient surgery group (saving in total cost 157 842.67 € / saving per patient 985.71 €).
Conclusions: Outpatient surgery in patients with uncomplicated acute appendicitis is effective. No higher number of complications, readmissions or reinterventions have been observed compared to the surgery group with admission. The perceived quality is similar in both groups. There is a significant saving in the surgery group without admission compared to the group with admission.
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