de Wijkerslooth Elisabeth M L, Bakas Jay M, van Rosmalen Joost, van den Boom Anne Loes, Wijnhoven Bas P L
Department of Surgery, Erasmus MC-University Medical Centre, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
Department of Biostatics, Erasmus MC-University Medical Centre, Rotterdam, the Netherlands.
Int J Colorectal Dis. 2021 Jun;36(6):1297-1309. doi: 10.1007/s00384-021-03872-3. Epub 2021 Feb 11.
Patients presenting with acute appendicitis are usually hospitalized for a few days for appendectomy and postoperative recovery. Shortening length of stay may reduce costs and improve patient satisfaction. The purpose of this study was to assess the safety of same-day discharge after appendectomy for acute appendicitis.
A systematic review was performed according to PRISMA guidelines. A literature search of EMBASE, Ovid MEDLINE, Web of Science, Cochrane Central, and Google Scholar was conducted from inception to April 14, 2020. Two reviewers independently screened the literature and selected studies that addressed discharge on the same calendar day as the appendectomy. Risk of bias was assessed with the ROBINS-I tool. Main outcomes were hospital readmission, complications, and unplanned hospital visits in the postoperative course. A random effects model was used to pool risk ratios for the main outcomes.
Of the 1912 articles screened, 17 comparative studies and 8 non-comparative studies met the inclusion criteria. Most only included laparoscopic procedure for uncomplicated appendicitis. Most studies were considered at moderate or serious risk of bias. In meta-analysis, same-day discharge (vs. overnight hospitalization) was not associated with increased rates of readmission, complication, and unplanned hospital visits. Non-comparative studies demonstrated low rates of readmission, complications, and unplanned hospital visits after same-day discharge.
This study suggests that same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis is safe without an increased risk of readmission, complications, or unplanned hospital visits. Hence, same-day discharge may be further encouraged in selected patients.
PROSPERO registration no. CRD42018115948.
急性阑尾炎患者通常需住院几天进行阑尾切除术及术后恢复。缩短住院时间可降低成本并提高患者满意度。本研究的目的是评估急性阑尾炎阑尾切除术后当日出院的安全性。
根据PRISMA指南进行系统评价。对EMBASE、Ovid MEDLINE、Web of Science、Cochrane Central和谷歌学术进行文献检索，检索时间从数据库建立至2020年4月14日。两名研究者独立筛选文献，选择与阑尾切除术后当日出院相关的研究。采用ROBINS-I工具评估偏倚风险。主要结局为术后再入院、并发症及非计划的医院就诊情况。采用随机效应模型汇总主要结局的风险比。
在筛选的1912篇文章中，17项比较性研究和8项非比较性研究符合纳入标准。大多数研究仅纳入了单纯性阑尾炎的腹腔镜手术。大多数研究被认为存在中度或严重的偏倚风险。在荟萃分析中，当日出院（与过夜住院相比）与再入院率、并发症及非计划的医院就诊率增加无关。非比较性研究表明当日出院后再入院、并发症及非计划的医院就诊率较低。
本研究表明，单纯性阑尾炎腹腔镜阑尾切除术后当日出院是安全的，不会增加再入院、并发症或非计划的医院就诊风险。因此，对于选定的患者，可进一步鼓励当日出院。
PROSPERO注册号CRD42018115948。
