Outpatient Appendectomy in an Emergency Outpatient Surgery Unit 24h a Day: An Intention-to-Treat Analysis of 194 Patients.

Abstract

To evaluate the feasibility and outcomes of patients operated on for uncomplicated acute appendicitis (UAA) in our 24-h emergency outpatient surgery unit. This was a prospective observational study with intention-to-treat (ITT) analysis. From 12/2013 to 03/2015, all consecutive patients admitted for acute appendicitis (AA) were prospectively screened. A computed tomography or abdominal ultrasound confirmed the diagnosis of AA. Eligibility criteria for outpatient appendectomy were: UAA, no comorbidity, no physical or mental condition preventing participation in the study, absence of pregnancy, age older than 15years, an accompanying adult person available for the hospital discharge and place of residence within 1h of our hospital. In the case of intraoperative complication (abscess, local or general peritonitis) or complication of general anesthesia, patients were excluded from the outpatient pathway. The primary endpoint was the feasibility of outpatient appendectomy among all consecutive patients admitted for UAA. Of the 194 screened patients, 150 (77%) presented an UAA and 102 (68%) were eligible for an outpatient procedure. Thirteen eligible patients (13%) were excluded from the outpatient circuit (7 intraoperative and 6 postoperative contraindications). Outpatient appendectomy was performed in 89 patients, representing 59% (89/150) of the ITT population and 87% (89/102) of the eligible patients. The median length of hospital stay was 13h. Postoperative complications were observed in six patients (6%). This study reports a safe and feasible management of UAA. Our organization allows a short hospitalization for postoperative recovery without using conventional surgery beds and enables discharge throughout the night.