Texas A&M Health Science Center, Department of Surgery, Scott & White Memorial Hospital, Temple, TX 76508, USA.
J Am Coll Surg. 2012 Jul;215(1):101-5; discussion 105-6. doi: 10.1016/j.jamcollsurg.2012.02.024. Epub 2012 May 19.
Many laparoscopic procedures are currently performed on an outpatient basis. Laparoscopic appendectomy, however, continues to require postoperative hospitalization at most institutions. A treatment protocol for outpatient laparoscopic appendectomy was developed to determine if this could be successfully performed without increasing postoperative complications. We hypothesized that adopting an outpatient protocol for laparoscopic appendectomy will significantly increase the rate of outpatient management for uncomplicated appendicitis, without an increase in morbidity or mortality.
We initiated a prospective outpatient protocol for laparoscopic appendectomy in July 2010 at our institution. All patients having laparoscopic appendectomy from July 2010 to March 2011 were included as protocol patients and were retrospectively reviewed. A separate group of patients having laparoscopic appendectomy from January to September 2009 were analyzed as historical controls. These 2 groups were compared for demographics, preoperative comorbidities, outpatient management, and postoperative morbidity by chi-square analysis, with a 0.95 confidence level for statistical significance.
A total of 116 protocol patients were compared with 119 historical control patients. There were no significant differences in patient demographics, preoperative comorbidities, and pathologic findings between protocol patients and historical controls. Ninety-nine protocol patients (85.3%) had procedures as outpatients compared with 42 historical control patients (35.3%; p < 0.05). Postoperative morbidity occurred in 6 protocol patients (5.2%) and 10 historical controls (8.4%; p = NS). There were no readmissions or mortalities in the protocol group.
An outpatient protocol for laparoscopic appendectomy significantly increased the rate of outpatient management with no increase in morbidity or mortality. This practice has now become standard of care at our institution.
目前许多腹腔镜手术都可在门诊进行。然而，大多数医疗机构仍要求腹腔镜阑尾切除术患者术后住院。我们制定了腹腔镜阑尾切除术门诊治疗方案，以确定是否可以在不增加术后并发症的情况下成功实施该方案。我们假设采用门诊方案进行腹腔镜阑尾切除术，不会增加发病率或死亡率，而可以显著提高单纯性阑尾炎的门诊治疗率。
自 2010 年 7 月起，我们在本院开始实施腹腔镜阑尾切除术门诊方案。所有 2010 年 7 月至 2011 年 3 月行腹腔镜阑尾切除术的患者都被纳入该方案，对其进行回顾性研究。另外，我们还分析了 2009 年 1 月至 9 月间行腹腔镜阑尾切除术的一组患者作为历史对照。采用卡方检验对两组患者的人口统计学资料、术前合并症、门诊管理和术后发病率进行比较，以 0.95 的置信水平作为统计学显著性标准。
共比较了 116 例方案患者和 119 例历史对照患者。两组患者的人口统计学资料、术前合并症和病理发现无显著差异。与 42 例历史对照患者（35.3%）相比，99 例方案患者（85.3%）接受了门诊手术（p<0.05）。6 例方案患者（5.2%）和 10 例历史对照患者（8.4%）发生术后并发症（p=NS）。方案组无患者再入院或死亡。
腹腔镜阑尾切除术门诊方案显著提高了门诊治疗率，且发病率和死亡率无增加。目前，该方案已成为我院的常规治疗方案。
