Overview
The potential benefit of outpatient care for this common digestive emergency is considerable, both for the patients themselves and for the public health system:
- Optimization of the care pathway, reducing the length of stay in hospital (a major issue in the context of the COVID-19 (coronavirus disease) pandemic) liberating patient beds and staff, and reducing the risk of nosocomial exposure.
- Improved patient satisfaction compared to waiting for hours in the emergency department due to lack of hospital beds.
- Non-inferiority of care in an outpatient unit in terms of quality and safety in day hospitalization.
- Significant decrease in the overall cost of this pathology as a result of a reduction in the hospital stay.
Eligibility
Inclusion Criteria:
- Patients aged 15-74 years
- BMI ≤ 30 kg/m2
- Uncomplicated acute appendicitis confirmed by imaging (ultrasound and/or CT and/or
MRI)
- Temperature ≤ 38,1°C and > 35,5°C
- Appendix diameter > 6mm and ≤ 15mm
- Without effusion or with only localized peri-appendicular effusion
- Infiltration of peri-appendicular fat without abscess or plastron
- No sign of perforation
- Leukocytes ≤ 15,000G/L AND
- CRP (C reactive protein) ≤ 50mg/L
- If pain, calmed by level 2 analgesic at maximum
- Ambulatory criteria
- Availability of monitoring by a relative during the 12 hours after discharge from the hospital
- Residence located less than 20 minutes by car from a health center (hospital or clinic)
- Access to a telephone mobile or fixed in case of problems
- Signature of the written informed consent form by the patient
- If the patient is a minor, signature of the written informed consent form by both parents or their legal representative
- Affiliation to a French health insurance scheme or equivalent
Exclusion Criteria:
- Criteria that exclude ambulatory care such as an ASA score (Physical status score) > 2, severe or uncontrolled comorbidities, severe pulmonary disease including obstructive sleep apnea, anticoagulation or antiplatelet drug or contraindication to ambulatory surgery such as intubation difficulties
- Presence of active cancer, a malignant hemopathy, drug addiction, coagulopathy, immunosuppressive treatment
- Non-acute or interval appendectomy, i.e. after antibiotic treatment of a complicated appendicitis of the plastron or drainage of an appendicular abscess;
- History of pelvic surgery
- Vulnerable people: pregnant or breast-feeding women (patients will undergo a pregnancy test: plasmatic β-hCG (human chorionic gonadotropin) or urinary test), adult under guardianship or deprived of freedom. Pregnant women are considered to have a full stomach, with risk of inhalation at anesthetic induction and represent a contraindication to ambulatory surgery. In addition, the need to perform abdominal surgery on a pregnant woman requires obstetric monitoring that is difficult to reconcile with management in an outpatient surgery unit (need for obstetric ultrasound or monitoring).
- Suspicion of a tumor of the appendix : Mucocele and pseudomyxoma, Carcinoid tumor, Adenocarcinoma of the appendix, Another type of tumor