title: Management of Acute Appendicitis in Ambulatory Surgery: Is It Possible? How to Select Patients?
abstract: OBJECTIVE
  Establish a protocol of management of acute appendicitis (AA) in ambulatory surgery (AmbSurg) on the basis of preoperative criteria.
  
  
  BACKGROUND
  Ambulatory laparoscopic appendectomy (LA) for AA has not been yet reported.
  
  
  METHODS
  All patients who underwent LA between 2010 and 2012 were reviewed. A multivariate analysis was performed to create a predictive score of discharge within the first 24 hours. The score was prospectively used on every AA from January 1, 2013, to December 15, 2013. All patients with 5 or 4 points were proposed for AmbSurg.
  
  
  RESULTS
  A total of 468 patients were included retrospectively, 181(38.7%) were discharged within the first 24 hours. In multivariate analysis, predictive factors of early discharge were body mass index less than 28 kg/m, white cell count less than 15,000/mL, C-reactive protein less than 30 mg/L, no radiological signs of perforation, and appendix diameter of 10 mm or smaller. Rate of discharge at day 1 was 72%, 45%, 39%, 21%, 0%, and 0% according to the score 5 to 0 (P < 0.0001). Prospectively, 184 patients had AA and 103 (56%) had a score of 4 or 5. Thirty-eight underwent ambulatory LA [16 (42%) patients were postponed to the next day and went back home]. All patients were directly discharged from recovery room, except 1 (2.6%) patient, after a mean hospital stay of 8.4 hours ± 6.9 hours. A total of 146 patients underwent LA in conventional surgery and 58% were discharged at day 1. Rate of early discharge was significantly associated with the score ranging from 0% to 92% for a score 0 or 5, validating prospectively the score (P < 0.0001).
  
  
  CONCLUSIONS
  We establish a simple validated predictive score of early discharge. When applied to AmbSurg, it allowed us to select patients eligible with a success rate of 97%.
authors.affiliation: From the Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, University Paris VI (Pierre and Marie Curie), Paris, France.
authors.forename: Magalie
authors.initials: M
authors.lastname: Lefrancois
authors.forename: Jérémie H
authors.initials: JH
authors.lastname: Lefevre
authors.forename: Najim
authors.initials: N
authors.lastname: Chafai
authors.forename: Sophie
authors.initials: S
authors.lastname: Pitel
authors.forename: Laure
authors.initials: L
authors.lastname: Kerger
authors.forename: Julie
authors.initials: J
authors.lastname: Agostini
authors.forename: Guillaume
authors.initials: G
authors.lastname: Canard
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tiret
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012189:Retrospective Studies; D055815:Young Adult