Our Summary

This study is about predicting which patients can have their appendix removed and go home within 24 hours (known as a short-stay appendectomy or SSA). To figure this out, researchers studied all the patients at their hospital who had their appendix removed through a small cut (laparoscopic appendectomy) from January 2013 to June 2015. They compared patient characteristics between the short-stay group and the group that needed to stay in the hospital longer.

They found that five factors were linked to having a successful short-stay appendectomy: being male, having a lower risk of serious complications during surgery (ASA class I-II), not having widespread muscle stiffness in the abdomen (generalized guarding), having a lower level of a protein in the blood that increases with inflammation (C-reactive protein <100 mg/dl), and having a lower white blood cell count (leukocyte count <20 g/l).

Based on these five factors, they made a scoring system to predict if a patient can have a short-stay appendectomy. If a patient’s score is 17 or higher (out of a possible 21), they are very likely to be able to be discharged within 24 hours of their surgery. This scoring system could help doctors decide who can be sent home early after an appendectomy.

FAQs

  1. What factors were found to predict a successful short-stay appendectomy?
  2. How can doctors predict if a patient can have a short-stay appendectomy?
  3. What is the significance of a score of 17 or higher in the scoring system created for predicting short-stay appendectomy?

Doctor’s Tip

A doctor might tell a patient that based on their characteristics and test results, they are a good candidate for a short-stay appendectomy, meaning they can likely go home within 24 hours after the surgery. This can help the patient feel more reassured and informed about their recovery process. Additionally, the doctor may advise the patient to follow post-operative instructions carefully to ensure a smooth recovery and to contact them if they experience any concerning symptoms.

Suitable For

Patients who are typically recommended for laparoscopic appendectomy include those who are male, have a lower risk of serious complications during surgery (ASA class I-II), do not have generalized guarding in the abdomen, have a lower level of C-reactive protein (<100 mg/dl), and have a lower white blood cell count (<20 g/l). These factors can help predict which patients are likely to have a successful short-stay appendectomy and be discharged within 24 hours of the surgery.

Timeline

Before laparoscopic appendectomy:

  • Patient presents with symptoms of appendicitis such as abdominal pain, nausea, vomiting, and fever.
  • Patient undergoes physical examination, blood tests, and imaging studies to confirm diagnosis of appendicitis.
  • Patient is scheduled for laparoscopic appendectomy surgery.

After laparoscopic appendectomy:

  • Patient undergoes laparoscopic appendectomy procedure, which involves making small incisions in the abdomen and removing the inflamed appendix.
  • Patient is monitored in the recovery room for a few hours post-surgery.
  • If the patient meets the criteria for a short-stay appendectomy, they may be discharged within 24 hours of surgery.
  • Patient is given instructions for post-operative care, including pain management, wound care, and diet restrictions.
  • Patient follows up with their surgeon for a post-operative appointment to ensure proper healing and recovery.

What to Ask Your Doctor

  1. Can I have a laparoscopic appendectomy instead of an open surgery?
  2. What are the potential risks and complications associated with a laparoscopic appendectomy?
  3. How long is the typical recovery time for a laparoscopic appendectomy?
  4. Will I need to stay in the hospital overnight or is it possible for me to have a short-stay appendectomy?
  5. What criteria will you use to determine if I am a good candidate for a short-stay appendectomy?
  6. What is my ASA class and how does it affect my eligibility for a short-stay appendectomy?
  7. What is my current C-reactive protein level and white blood cell count, and how do they impact my ability to have a short-stay appendectomy?
  8. What is my score on the predictive scoring system for short-stay appendectomy, and what does that mean for my treatment plan?
  9. What follow-up care will I need after the surgery, and how can I ensure a smooth recovery process?
  10. Are there any specific lifestyle changes or precautions I should take after having a laparoscopic appendectomy?

Reference

Authors: Vuagniaux A, Gié O, Butti F, Marques-Vidal PM, Demartines N, Mantziari S. Journal: World J Surg. 2019 Nov;43(11):2771-2778. doi: 10.1007/s00268-019-05115-7. PMID: 31407096