Davina Perini (Florence / IT), Jacopo Martellucci (Florence / IT), Maximilian Scheiterle (Florence / IT), Francesca Cammelli (Florence / IT), Annamaria di Bella (Florence / IT), Paolo Prosperi (Florence / IT)
Introduction:
Over the past decades, appendectomies have been increasingly performed as "short-stay" or "ambulatory" procedures, with satisfactory outcomes and low complication rates. Yet, conventional hospitalization remains the routine procedure for acute appendicitis.
Objective:
This study was designed to validate day-stay laparoscopic appendectomy (LA) for non-complicated acute appendicitis (ncAA)
Materials & Methods:
We retrospectively reviewed a consecutive series of 560 LA for acute appendicitis, performed in the last 3 years. Whenever possible, patients were offered 1-day appendectomy, defined as "discharge within 24h". Furthermore, we determine predictive factors for successful day-stay surgery (LOS <24 h). In light of these findings, in 2023 we"ve started a prospective 1-day protocol of LA for ncAA at our institution. We prospectively analyzed outcomes and postoperative complications of the 50 patients who underwent 1-day appendectomy.
Results:
The average length of stay of the 560 patients retrospectively analyzed was 3.1 days. We also highlighted that there were no statistically significant differences between patients discharged in I, II or III POD, regarding both preoperative parameters (AIR score and Alvarado score) and intraoperative parameters (Mannheim Peritonitis Index). Moreover, predictive factors for safe and feasible day-stay surgery were AIR score < 6 and Mannheim Peritonitis Index > 11. In 2023, none of the 50 patients undergoing 1-day appendectomy reported major complications or 30-day hospital readmissions.
Conclusions:
1-day protocol for laparoscopic appendectomy significantly increased the rate of outpatient management with more comfort for patients and no increase in morbidity or mortality. Because of the positive results from our study, this practice has now become the standard of care for ncAA at our institution.
•LaFrançois M et al. Management of acute appendicitis in ambulatory surgery: is it possible? How to select patients? Ann Surg 2015;261:1167—72.
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