Management of Uncomplicated Acute Appendicitis as Day Case Surgery: Feasibility and a Critical Analysis of Exclusion Criteria and Treatment Failure
| Autor: | Thierry Lion, Gérard Grelpois, Charles Sabbagh, Brice Robert, Jean-Marc Regimbeau, E. Chapuis-Roux, A. Ntouba, Cyril Cosse |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Population 030230 surgery 03 medical and health sciences 0302 clinical medicine Patient satisfaction Quality of life medicine Clinical endpoint Appendectomy Humans Prospective Studies Treatment Failure education Aged Aged 80 and over education.field_of_study Intention-to-treat analysis business.industry Patient Selection Perioperative Middle Aged Appendicitis Surgery Intention to Treat Analysis Ambulatory Surgical Procedures 030220 oncology & carcinogenesis Emergency medicine Acute appendicitis Acute Disease Feasibility Studies Female business Cohort study |
| Zdroj: | Journal of the American College of Surgeons. 223(5) |
| ISSN: | 1879-1190 |
| Popis: | Background Day case surgery (DCS) for uncomplicated acute appendicitis (NCAA) is evaluated. The objective of this prospective, single-center, descriptive, nonrandomized, intention-to-treat cohort study was to assess the feasibility of DCS for NCAA with a critical analysis of the reasons for exclusion and treatment failures and a focus on patients discharged to home and admitted for DCS on the following day. Study Design From April 2013 to December 2015, NCAA patients meeting the inclusion criteria were included in the study. The primary end point was the success rate for DCS (length of stay less than 12 hours) in the intention-to-treat population (all NCAA) and in the per-protocol population (no pre- or perioperative exclusion criteria). The secondary end points were morbidity, DCS quality criteria, predictive factors for successful DCS, patient satisfaction, quality of life, and reasons for pre- or perioperative exclusion. A subgroup of patients discharged to home the day before operation was also analyzed. Results A total of 240 patients were included. The success rate of DCS was 31.5% in the intention-to-treat population and 91.5% in the per-protocol population. The rates of unplanned consultations, hospitalization, and reoperation were 13%, 4%, and 1%, respectively. An analysis of the reasons for DCS exclusion showed that 73% could have been modified. For the 68 patients discharged to home on the day before operation, the DCS success rate was 91%. Conclusions Day case surgery is feasible in NCAA. A critical analysis of the reasons for exclusion from DCS showed that it should be possible to dramatically increase the eligible population. |
| Databáze: | OpenAIRE |
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