Lord R V, Sloane D R
Department of Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.
Aust N Z J Surg. 1996 Jun;66(6):361-5. doi: 10.1111/j.1445-2197.1996.tb01211.x.
There is increasing pressure on surgeons to minimize the time patients stay in hospital, and there is therefore a need to establish guidelines for reasonable lengths of stay for common operations. This study was conducted to test the feasibility and safety of early discharge after open appendicectomy. In addition, this study was performed to provide standards for open appendicectomy against which the results of laparoscopic appendicectomy can be compared.
A prospective study of all patients having open appendicectomy for suspected acute appendicitis at Liverpool Hospital, Sydney during a 4 month period was undertaken. An early discharge programme was established, with the aim of discharging patients within 48 h of operation in uncomplicated cases. Discharge was allowed when the patient was eating, walking, and had passed flatus. Follow up was with the consultant surgeon at 1 week postoperatively, and with a community nurse at 2 weeks. Multivariate linear regression, using the number of postoperative hours to discharge as the outcome, was used to analyse the data for the following four factors: age, gender, incision type, and pathology.
One hundred and sixteen consecutive patients were enrolled in the study. The median postoperative stay for all patients was 46 h. Perforation of the appendix, use of a midline laparotomy for appendicectomy, and age significantly prolonged hospital stay, but gender had no effect. The main complication was wound infection, which was seen in 7.5% of patients. No patient had a problem directly related to early discharge. A community nurse saw 81% of patients 2 weeks after discharge. Over three-quarters of the patients seen had returned to full normal activities by 2 weeks, including work or school. Eighty-eight per cent of patients considered the timing of their discharge "good' or "excellent'.
Discharge at 2 days after open appendicectomy is both feasible and safe for patients having an unperforated appendix removed through a right iliac fossa incision. Passage of stool is not required prior to discharge. Early discharge is well accepted by patients and may result in financial savings for hospitals where payment is according to Diagnosis-Related Groups. On the basis of the results of the six randomized controlled trials comparing laparoscopic and conventional open appendicectomy published to date, and on the results of this study, the authors conclude that laparoscopic appendicectomy should not yet be considered the "procedure of choice', and surgeons are justified in performing appendicectomy by either method.
外科医生面临着缩短患者住院时间的越来越大的压力，因此有必要为常见手术制定合理的住院时长指南。本研究旨在测试开放性阑尾切除术后早期出院的可行性和安全性。此外，本研究还旨在提供开放性阑尾切除术的标准，以便与腹腔镜阑尾切除术的结果进行比较。
对悉尼利物浦医院在4个月期间因疑似急性阑尾炎接受开放性阑尾切除术的所有患者进行了一项前瞻性研究。制定了一项早期出院计划，目标是在无并发症的情况下，患者在术后48小时内出院。当患者能够进食、行走且已排气时允许出院。术后1周由外科顾问医生进行随访，术后2周由社区护士进行随访。以术后出院小时数作为结果，采用多元线性回归分析以下四个因素的数据：年龄、性别、切口类型和病理情况。
116例连续患者纳入本研究。所有患者术后中位住院时间为46小时。阑尾穿孔、采用中线剖腹阑尾切除术以及年龄显著延长了住院时间，但性别没有影响。主要并发症是伤口感染，见于7.5%的患者。没有患者出现与早期出院直接相关的问题。社区护士在出院后2周看望了81%的患者。超过四分之三接受看望的患者在2周时已恢复完全正常活动，包括工作或上学。88%的患者认为其出院时间“良好”或“优秀”。
对于通过右下腹切口切除非穿孔性阑尾的患者，开放性阑尾切除术后2天出院是可行且安全的。出院前不需要排便。患者对早期出院接受度良好，对于按诊断相关分组付费的医院可能会节省费用。基于迄今发表的六项比较腹腔镜和传统开放性阑尾切除术的随机对照试验结果以及本研究结果，作者得出结论，腹腔镜阑尾切除术目前不应被视为“首选术式”，外科医生采用任何一种方法进行阑尾切除术都是合理的。
