One-day appendectomy: more an opportunity than a challenge. A prospective protocol

Area of Science:

• Surgical innovation
• Patient management pathways
• Appendicitis treatment

Background:

• Laparoscopic appendectomy (LA) short-stay pathways are gaining acceptance.
• Conventional hospitalization persists for acute appendicitis (AA).
• Need to evaluate a structured one-day LA protocol and refine selection criteria.

Purpose of the Study:

• Assess the safety and feasibility of a one-day LA protocol (discharge within 24 hours).
• Refine patient selection criteria for early discharge after LA.

Main Methods:

• Two-phase observational study: retrospective analysis followed by prospective validation.
• Defined eligibility criteria for one-day discharge.
• Logistic regression to identify barriers to protocol adherence.

Main Results:

• Early discharge was safely achieved in 812 LA patients, with no increase in complications or readmissions.
• In prospective phase, 132 patients met criteria; 90 were discharged within 24 hours.
• Operator-dependent factors (drainage, operative time) were primary barriers to protocol adherence.

Conclusions:

• A structured one-day LA protocol is safe, feasible, and effective for selected patients.
• The one-day pathway is now standard of care for uncomplicated AA at the institution.