title: Management of Uncomplicated Acute Appendicitis as Day Case Surgery: Feasibility and a Critical Analysis of Exclusion Criteria and Treatment Failure.
abstract: 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.
  
  
  
  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.
  
  
  
  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%.
  
  
  
  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.
authors.affiliation: Department of Digestive Surgery, Amiens-Picardie University Medical Center, Amiens, France; Clinical Research Center, Amiens-Picardie University Medical Center, Amiens, France; Department of Digestive Surgery, University of Picardie Jules Verne, Amiens, France; Virology Research Unit, University of Picardie Jules Verne, Amiens, France; Clinical Research Center, University of Picardie Jules Verne, Amiens, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Grelpois
authors.affiliation: Department of Digestive Surgery, Amiens-Picardie University Medical Center, Amiens, France; Department of Digestive Surgery, University of Picardie Jules Verne, Amiens, France; Institut National de la Santé et de la Recherche Médicale UMR-S 1088, University of Picardie Jules Verne, Amiens, France; University of Picardie Jules Verne, Amiens, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Sabbagh
authors.affiliation: Department of Digestive Surgery, Amiens-Picardie University Medical Center, Amiens, France; Clinical Research Center, Amiens-Picardie University Medical Center, Amiens, France; Department of Digestive Surgery, University of Picardie Jules Verne, Amiens, France; Clinical Research Center, University of Picardie Jules Verne, Amiens, France; Institut National de la Santé et de la Recherche Médicale UMR-S 1088, University of Picardie Jules Verne, Amiens, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Cosse
authors.affiliation: Department of Radiology and Medical Imaging, Amiens-Picardie University Medical Center, Amiens, France; Department of Radiology and Medical Imaging, University of Picardie Jules Verne, Amiens, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Robert
authors.affiliation: Department of Digestive Surgery, Amiens-Picardie University Medical Center, Amiens, France; Department of Digestive Surgery, University of Picardie Jules Verne, Amiens, France; University of Picardie Jules Verne, Amiens, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Chapuis-Roux
authors.affiliation: Department of Anesthesia, Amiens-Picardie University Medical Center, Amiens, France; Department of Anesthesia, University of Picardie Jules Verne, Amiens, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ntouba
authors.affiliation: Emergency Department, Amiens-Picardie University Medical Center, Amiens, France; Emergency Department, University of Picardie Jules Verne, Amiens, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lion
authors.affiliation: Department of Digestive Surgery, Amiens-Picardie University Medical Center, Amiens, France; Clinical Research Center, Amiens-Picardie University Medical Center, Amiens, France; Department of Digestive Surgery, University of Picardie Jules Verne, Amiens, France; Virology Research Unit, University of Picardie Jules Verne, Amiens, France; Clinical Research Center, University of Picardie Jules Verne, Amiens, France; University of Picardie Jules Verne, Amiens, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D017211:Treatment Failure