Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy

Abstract

Objective: This manuscript is a mini review of the outpatient management of non-complicated acute appendicitis. We reviewed the literature supporting the safety and efficacy of outpatient management of laparoscopic appendectomy in adult patients with uncomplicated acute appendicitis. Background Data: Outpatient laparoscopic appendectomy is feasible and safe in selected patients in observational studies. Benefits include reduced length of stay (LOS) and postoperative complications. Data reported in 17 studies (mainly retrospective) suggested that outpatient appendectomy might be feasible. Several observational studies have shown that outpatient surgery is not associated with increased readmissions, increased morbidity rates, or reoperation. Until 2022, international guidelines supported the clinical efficacy and safety of outpatient appendectomy. However, the strength of the evidence is weak and recommendations cannot be given. In November 2022, the first randomized controlled trial (RCT) of outpatient treatment according to the ERAS protocol was published. In this study, the length of stay was significantly shorter. There were no differences in readmission rates. No further emergency consultations or complications were observed. The outpatient management had presented an economic saving. Conclusion: Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost.