Same Day Discharge after Emergency Appendicectomy: Is it Feasible?

Abstract

Introduction: In the UK, approximately 70,000 appendicectomies (one of the most common surgical procedures) are performed yearly. There is a wide variation in length of stay following Laparoscopic Appendicectomy (LA). Aim: To review the feasibility of safe same day discharge following LA for patients with acute appendicitis. Materials and Methods: This was a retrospective review of 92 consecutive adults (≥18 years) who underwent emergency appendicectomy in a District General Hospital (DGH), between April and July 2018. The patients were divided into two groups. Group A comprised all patients not discharged on day of operation while Group B comprised all patients discharged on same day of operation. Data collected and analysed included demographics, clinical diagnosis, WBC, CRP, operative details, complications and length of stay. Outcomes were compared using Fisher’s exact test. Results: Group A: Total 86 (93%), included male: female of 38:48, age 36 years (median), range (18-81) years, heart rate 78(median), range (51-162)/minute, temperature 36.8°C (median), range (35.7-40.2)°C, WBC 13.5 (median), range (3.8-25.6), CRP 36 (median), range (2-498) and PO stay 1 (median), range (1-11) days. Group B: Total 6(7%), included male:female of 2: 4 with age of 27 years (median), range (18-49) years, temperature 36.8°C (median), range (36.5-39.2) °C, WBC 10.5 (median), range (7-15.6), CRP 5.5 (median), range (1-94) and PO stay of 0 day. Four had uncomplicated appendicitis, 1 had pus and 1 had appendicular mass with pus. Five out of six patients had LA and were operated before noon. Group B had no complications including no re-admissions. Conclusion: Selective approach to same day discharge, for medically fit patients undergoing emergency laparoscopic appendicectomy, is safe. Complicated appendicitis is not an absolute contraindication to same day discharge.

Keywords

• appendicitis
• laparoscopic appendicectomy
• length of stay