Factors determining the return to normal activity after appendicectomy

The ability of a patient to return to their normal activities is an important outcome of an operation. The present study was designed to identify and rank factors that are important in determining this return to normal activity (RTNA) after appendicectomy.

Consecutive patients were identified prospectively following appendicectomy at North Shore Hospital between February and April 2000. Data regarding 25 different factors were obtained by a structured patient interview before and after discharge from hospital and by review of the medical records. Statistical analysis involved analysis of variance and logistic regression analysis.

There were 98 patients (median age 28, range 15-69 years, male : female ratio 48:50) who had an appendicectomy. An open appendicectomy was performed in 74 patients, a laparoscopic appendicectomy in 22 patients and a laparotomy in two patients. This includes the 16 patients who were converted from laparoscopic to open appendicectomy (conversion rate 42% 16/38). Acute appendicitis was confirmed by histology in 67 (68%) patients. The significant independent variables identified by anova were ranked by logistic regression analysis. The most important determinant for the time to RTNA was what the doctor advised (chi-squared 43.7, P < 0.0001). The other determinants were the physical activity of their primary occupation (chi-squared 21.5, P < 0.017), the need for strong postdischarge analgesia (chi-squared 21.1, P < 0.13), the American Society of Anesthesiologists (ASA) category (chi-squared 13.6, P < 0.018) and the total sick leave obtained (chi-squared 9.6, P < 0.08).

It has been shown that the most significant factor in determining the RTNA after appendicectomy was the advice given by the doctor, and that this was more important than the surgical approach, pathology, complications, age or occupation of the patient.