Our Summary

This study looks at the use of same-day surgery (ambulatory surgery) for treating acute appendicitis, which is the most common cause of sudden abdominal pain requiring surgery. The researchers looked at data from 1,730 patients who went through this procedure between March 2013 and June 2020. They found that almost a quarter of these surgeries were done on an ambulatory basis. They used a scoring system called the St-Antoine’s score, which considers clinical symptoms and imaging studies, to determine which patients were eligible for same-day surgery.

Results showed that 83% of the ambulatory group met the criteria (score ≥4), and about 91% were able to go home on the same day of the surgery. The rates of unplanned follow-up visits and readmissions to the hospital were not significantly different between the ambulatory group and those who had traditional inpatient surgery. The study also found that patients without evidence of perforation on imaging studies were more likely to be discharged early.

The researchers suggest that the St-Antoine’s score is a safe way to decide who can have same-day surgery for acute appendicitis. They also recommend that all patients who do not show signs of perforation on imaging studies should be considered for same-day surgery. This would increase the number of patients eligible for this type of surgery by 60%.

FAQs

  1. What is the St-Antoine’s score and how is it used in determining eligibility for same-day surgery in acute appendicitis cases?
  2. What percentage of patients were able to go home on the same day of their ambulatory surgery for acute appendicitis, according to the study?
  3. What is the recommended procedure for patients who show no signs of perforation on their imaging studies according to the researchers?

Doctor’s Tip

One helpful tip a doctor might tell a patient about appendectomy is to follow post-operative care instructions carefully. This includes taking prescribed medications, getting plenty of rest, avoiding heavy lifting and strenuous activities, and eating a healthy diet to promote healing. It’s also important to watch for signs of infection or complications, such as increased pain, fever, or redness/swelling at the incision site, and to contact your doctor if you experience any of these symptoms. By following these guidelines, you can help ensure a smooth recovery after your appendectomy.

Suitable For

Typically, patients who are recommended for appendectomy are those who are diagnosed with acute appendicitis, which is the most common reason for sudden abdominal pain requiring surgery. Patients who do not show signs of perforation on imaging studies and have a St-Antoine’s score of 4 or higher are usually considered eligible for same-day surgery. This includes patients who are otherwise healthy and do not have any significant medical conditions that would require them to stay in the hospital for an extended period of time.

Timeline

Before appendectomy:

  1. Patient experiences sudden abdominal pain that may be accompanied by nausea, vomiting, and fever.
  2. Patient seeks medical attention and undergoes physical examination and imaging studies to diagnose acute appendicitis.
  3. Patient may be admitted to the hospital for observation and further evaluation.

After appendectomy:

  1. Patient undergoes surgery to remove the appendix, either through traditional inpatient surgery or same-day surgery (ambulatory surgery).
  2. If eligible for same-day surgery, patient is discharged home on the same day of the surgery.
  3. Patient may experience some pain and discomfort post-surgery, which can be managed with pain medication.
  4. Patient may have a follow-up visit with the surgeon to ensure proper healing and recovery.
  5. Overall, patients who undergo appendectomy experience relief from the symptoms of acute appendicitis and typically have a full recovery within a few weeks.

What to Ask Your Doctor

  1. Am I a candidate for same-day surgery for my appendectomy based on the St-Antoine’s score?
  2. What are the benefits of same-day surgery compared to traditional inpatient surgery for appendectomy?
  3. Are there any potential risks or complications associated with same-day surgery for appendectomy?
  4. How will pain management be addressed after the surgery if I go home on the same day?
  5. What should I expect in terms of recovery and follow-up care after a same-day appendectomy?
  6. How will I know if I need to seek medical attention after going home following same-day surgery?
  7. What criteria will be used to determine if I am eligible for same-day surgery for my appendectomy?
  8. Will I have access to a healthcare provider or nurse if I have questions or concerns after the surgery?
  9. How will my post-operative care be different if I have same-day surgery versus traditional inpatient surgery for appendectomy?
  10. Are there any specific instructions or precautions I should follow before and after undergoing same-day surgery for appendectomy?

Reference

Authors: Raimbert P, Voron T, Laroche S, O’Connell L, Debove C, Challine A, Parc Y, Lefèvre JH. Journal: Surgery. 2023 May;173(5):1129-1136. doi: 10.1016/j.surg.2023.01.003. Epub 2023 Feb 10. PMID: 36775758