Preoperative Clinical Factors Associated with Short-Stay Laparoscopic Appendectomy.

Details

Serval ID
serval:BIB_D0840710C910
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Preoperative Clinical Factors Associated with Short-Stay Laparoscopic Appendectomy.
Journal
World journal of surgery
Author(s)
Vuagniaux A., Gié O., Butti F., Marques-Vidal P.M., Demartines N., Mantziari S.
ISSN
1432-2323 (Electronic)
ISSN-L
0364-2313
Publication state
Published
Issued date
11/2019
Peer-reviewed
Oui
Volume
43
Number
11
Pages
2771-2778
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Outpatient appendectomy for acute appendicitis is a feasible, yet not widely performed procedure, as there are no universally accepted criteria for patient selection. The aim of this study was to assess preoperative clinical factors associated with successful short-stay appendectomy (SSA) and establish a predictive score to help with patient selection.
All consecutive laparoscopic appendectomies performed in our institution between January 2013 and June 2015 were retrospectively analyzed. Several preoperative clinical and biological variables were compared between patients with SSA, defined as a postoperative stay <24 h, and those needing inpatient care. Logistic regression analysis was used to identify variables independently associated with SSA, and these variables were then used to create a predictive score.
A total of 578 patients were included, 303 (53%) in the SSA group and 275 (48%) in the long-stay appendectomy (LSA) group. In multivariate analysis, male gender (OR 1.61, 95% CI 1.12-2.31, p = 0.010), ASA class I-II (OR 9.52, 95% CI 1.65-180.69, p = 0.037), absence of generalized guarding (OR 3.55, 95% CI 1.30-11.41, p = 0.019), C-reactive protein <100 mg/dl (OR 3.09, 95% CI 1.81-5.42, p < 0.001) and leukocyte count <20 g/l (OR 2.06, 95% CI 1.02-4.30, p = 0.046) were independently associated with SSA. These five parameters were used to construct a predictive score, whereby ≥17 (range 0-21) was defined as the optimal threshold to predict SSA with a high sensitivity (95.6%) and negative predictive value (82.2%).
A purely clinical predictive score based on five widely used preoperative parameters can be used to identify eligible patients for short-stay appendectomy.
Keywords
Adolescent, Adult, Aged, Aged, 80 and over, Appendectomy/methods, Appendicitis/surgery, Female, Humans, Laparoscopy/methods, Length of Stay, Logistic Models, Male, Middle Aged, Retrospective Studies, Young Adult
Pubmed
Web of science
Create date
16/08/2019 18:09
Last modification date
25/07/2020 6:19
Usage data