Frazee Richard, Burlew Clay Cothren, Regner Justin, McIntyre Robert, Peltz Erik, Cribari Chris, Dunn Julie, Butler Larry, Reckard Paul, Dissanaike Sharmila, Karimi Karen, Behnfield Charles, Melo Nic, Margulies Daniel
Baylor Scott & White Healthcare, Dallas, TX, USA.
Denver Health and Hospital Authority, Denver, CO, USA.
Am J Surg. 2017 Dec;214(6):1007-1009. doi: 10.1016/j.amjsurg.2017.08.029. Epub 2017 Sep 19.
Many laparoscopic procedures are now performed on an outpatient basis. We hypothesize laparoscopic appendectomy can be safely performed as an outpatient procedure.
Seven institutions adopted a previously described outpatient laparoscopic appendectomy protocol for uncomplicated appendicitis. Patients were dismissed unless there was a clinical indication for admission. Patient demographics, success with outpatient management, time of dismissal, morbidity, and readmissions were analyzed.
Two hundred six men and one hundred seventy women with a mean age of 35.4 years were included in the protocol. Seventy-eight patients (21%) had pre-existing comorbidities. 299 patients (80%) were managed as outpatients. There were no conversions to open appendectomy. Postoperative morbidity was 5%. The time of patient dismissals was evenly distributed throughout the day and night. Twelve patients (3%) required readmission. Outpatient follow-up occurred in 63% of patients.
An outpatient laparoscopic appendectomy protocol was successfully applied at multiple institutions with low morbidity and low readmission rates. Application of this practice nationally could reduce length of stay and decrease overall health care costs for acute appendicitis.
目前许多腹腔镜手术在门诊进行。我们假设腹腔镜阑尾切除术可作为门诊手术安全实施。
七家机构采用了先前描述的针对单纯性阑尾炎的门诊腹腔镜阑尾切除术方案。除非有临床住院指征，患者均予以出院。分析了患者的人口统计学特征、门诊管理的成功率、出院时间、发病率和再入院情况。
该方案纳入了206名男性和170名女性，平均年龄35.4岁。78名患者（21%）有既往合并症。299名患者（80%）作为门诊患者管理。无转为开腹阑尾切除术的情况。术后发病率为5%。患者出院时间在白天和夜间均匀分布。12名患者（3%）需要再次入院。63%的患者进行了门诊随访。
门诊腹腔镜阑尾切除术方案在多家机构成功应用，发病率和再入院率较低。在全国范围内应用这种做法可缩短住院时间并降低急性阑尾炎的总体医疗费用。
