Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial
Abstract Objective To confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an enhanced recovery after surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis. Summary background data Outpatient laparoscopic appendectomy is feasible and...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-022-00465-5 |
| _version_ | 1811187015700447232 |
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| author | Jordi Elvira López Ricard Sales Mallafré Erlinda Padilla Zegarra Luis Carrillo Luna Joan Ferreres Serafini Roisin Tully Robert Memba Ikuga Rosa Jorba Martin |
| author_facet | Jordi Elvira López Ricard Sales Mallafré Erlinda Padilla Zegarra Luis Carrillo Luna Joan Ferreres Serafini Roisin Tully Robert Memba Ikuga Rosa Jorba Martin |
| author_sort | Jordi Elvira López |
| collection | DOAJ |
| description | Abstract Objective To confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an enhanced recovery after surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis. Summary background data Outpatient laparoscopic appendectomy is feasible and secure in selected patients in observational studies. The benefits include reduced length of stay (LOS) and postoperative complications. This is the first randomized controlled trial of outpatient management following ERAS protocol. Methods Patients admitted from the emergency department with acute appendicitis were randomized into one of two groups: standard care within the hospital (HG) or the outpatient group (OG). An ERAS protocol was followed for both groups. Patients in the HG were admitted to the surgical ward. Patients in the OG were referred to the day-surgery unit. The primary endpoint was the length of stay. Results Ninety-seven patients were included: 49 in the OG and 48 in the HG. LOS was significantly shorter in the OG (mean 8.82 h) than in the HG (mean 43.53 h), p < 0.001. There was no difference in readmission rates (p = 0.320); we observed only one readmission in the OG. No further emergency consultations or complications were observed. The cost saving was $516.52/patient as a result of the intervention. Conclusion Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost. Trial registration: Registration: www.clinicaltrials.gov (NCT05401188) Clinical Trial ID: NCT05401188 |
| first_indexed | 2024-04-11T13:55:06Z |
| format | Article |
| id | doaj.art-852fa019484940af96d6aae66002cfcb |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-04-11T13:55:06Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-852fa019484940af96d6aae66002cfcb2022-12-22T04:20:22ZengBMCWorld Journal of Emergency Surgery1749-79222022-11-011711910.1186/s13017-022-00465-5Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trialJordi Elvira López0Ricard Sales Mallafré1Erlinda Padilla Zegarra2Luis Carrillo Luna3Joan Ferreres Serafini4Roisin Tully5Robert Memba Ikuga6Rosa Jorba Martin7General and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili UniversityGeneral and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili UniversityGeneral and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili UniversityAnesthesiology Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili UniversityGeneral and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili UniversityGeneral Surgery Department, St Vincent’s University HospitalGeneral and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili UniversityGeneral and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Rovira i Virgili UniversityAbstract Objective To confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an enhanced recovery after surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis. Summary background data Outpatient laparoscopic appendectomy is feasible and secure in selected patients in observational studies. The benefits include reduced length of stay (LOS) and postoperative complications. This is the first randomized controlled trial of outpatient management following ERAS protocol. Methods Patients admitted from the emergency department with acute appendicitis were randomized into one of two groups: standard care within the hospital (HG) or the outpatient group (OG). An ERAS protocol was followed for both groups. Patients in the HG were admitted to the surgical ward. Patients in the OG were referred to the day-surgery unit. The primary endpoint was the length of stay. Results Ninety-seven patients were included: 49 in the OG and 48 in the HG. LOS was significantly shorter in the OG (mean 8.82 h) than in the HG (mean 43.53 h), p < 0.001. There was no difference in readmission rates (p = 0.320); we observed only one readmission in the OG. No further emergency consultations or complications were observed. The cost saving was $516.52/patient as a result of the intervention. Conclusion Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost. Trial registration: Registration: www.clinicaltrials.gov (NCT05401188) Clinical Trial ID: NCT05401188https://doi.org/10.1186/s13017-022-00465-5AppendicitisAcute appendicitisUncomplicated acute appendicitisOutpatient managementLaparoscopic appendectomyERAS protocol |
| spellingShingle | Jordi Elvira López Ricard Sales Mallafré Erlinda Padilla Zegarra Luis Carrillo Luna Joan Ferreres Serafini Roisin Tully Robert Memba Ikuga Rosa Jorba Martin Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial World Journal of Emergency Surgery Appendicitis Acute appendicitis Uncomplicated acute appendicitis Outpatient management Laparoscopic appendectomy ERAS protocol |
| title | Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial |
| title_full | Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial |
| title_fullStr | Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial |
| title_full_unstemmed | Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial |
| title_short | Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial |
| title_sort | outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy a randomized controlled trial |
| topic | Appendicitis Acute appendicitis Uncomplicated acute appendicitis Outpatient management Laparoscopic appendectomy ERAS protocol |
| url | https://doi.org/10.1186/s13017-022-00465-5 |
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