Department of General, Visceral and Endocrine Surgery, Clinique de la Sauvegarde, Lyon, France.
Department of Anesthesiology, Clinique de la Sauvegarde, Lyon, France.
World J Emerg Surg. 2018 Jun 28;13:28. doi: 10.1186/s13017-018-0191-4. eCollection 2018.
Appendectomy is increasingly performed as a 'short stay' or 'ambulatory' procedure, yet there is no consensus for selection of patients with acute appendicitis for ambulatory surgery (AS). We aimed to compare characteristics and outcomes of complicated and uncomplicated appendectomies performed in ambulatory vs. conventional settings, and to determine factors associated with unexpected re-consultations and re-hospitalizations.
The authors reviewed a consecutive series of 185 laparoscopic appendectomies. Whenever possible, patients were offered AS, defined as 'discharge on the same working day.' Multivariable regressions were performed to determine associations of unexpected re-consultations and re-hospitalizations with surgery type (ambulatory or conventional) and patient characteristics (age, gender, obesity, symptoms, appendicolith, perforations, appendix diameter, serologic results, American Society of Anesthesiologists score, and Saint-Antoine score).
From the initial cohort, 117 patients (63.2%) were eligible for AS, of which 8 had peri- or post-operative contraindications. Therefore, 109 patients (58.9%) were operated by AS, with median length of stay 8.5 h (range, 3.3-20.5). Ambulatory cases had a lower incidence of complications (11.9%) than conventional cases (25.0%) ( = 0.029). Uni- and multi-variable regressions revealed that unexpected re-consultations were not significantly associated with any of the pre- or peri-operative variables but that unexpected re-hospitalizations were 4 times more likely for patients with appendicolith (OR, 4.32; = 0.04).
Ambulatory surgery could be considered as a standard procedure for both complicated and uncomplicated acute appendicitis. Appendicolith was found to be an independent risk factor for unexpected re-hospitalization and should therefore trigger closer monitoring.
阑尾切除术越来越多地作为“短期住院”或“非住院”手术进行，但对于选择适合门诊手术（AS）的急性阑尾炎患者尚无共识。我们旨在比较在门诊和常规环境下进行的复杂和非复杂阑尾切除术的特征和结果，并确定与意外复诊和再入院相关的因素。
作者回顾了连续的 185 例腹腔镜阑尾切除术。只要有可能，就为患者提供 AS，定义为“在同个工作日出院”。进行多变量回归以确定意外复诊和再入院与手术类型（门诊或常规）和患者特征（年龄、性别、肥胖、症状、阑尾结石、穿孔、阑尾直径、血清学结果、美国麻醉医师协会评分和圣安东尼评分）的关联。
从初始队列中，有 117 名患者（63.2%）符合 AS 条件，其中 8 名患者在围手术期存在禁忌证。因此，有 109 名患者（58.9%）通过 AS 进行手术，中位住院时间为 8.5 小时（范围为 3.3-20.5 小时）。与常规病例（25.0%）相比，门诊病例的并发症发生率（11.9%）较低（=0.029）。单变量和多变量回归显示，意外复诊与任何术前或围手术期变量均无显著关联，但对于有阑尾结石的患者，意外再入院的可能性增加了 4 倍（OR，4.32；=0.04）。
门诊手术可被视为复杂和非复杂急性阑尾炎的标准手术。阑尾结石被发现是意外再入院的独立危险因素，因此应加强监测。
