Principles o af safe day case appendicectomy and patient satisfaction rates: a systematic review.

Background: Acute appendicitis is one of the most common surgical pathologies. While literature reports safe day-case appendicectomies in uncomplicated cases, hesitancy exists in discharging patients on the day of surgery. This study addresses the criteria for day-case surgery, patient selection, reported clinical risks versus benefits, complications, rates of readmission and patient satisfaction. Methods: A literature review was carried out in PubMed and Medline for day-case appendicectomy, patient safety, day case surgery and National Health Service. British Association of Day Surgery recommendations were reviewed in relation to appendicectomy as a day-case. Results: From the 146 identified papers, 19 fulfilled the inclusion criteria. Variability was noted in the definition of same-day discharge. Included patients had uncomplicated appendicitis, postoperative pain well managed by non-opioid analgesia, no clinical concerns and care at home. Age under 65 years, American Society of Anaesthesiologists (ASA) 1 or 2, absence of insulin-dependent diabetes and immunosuppressant therapy were also part of the inclusion criteria. No statistically significant difference was found in rates of reintervention and reoperation between admitted and discharged patients. Reasons for overnight admission were due to patient (age, comorbidities, etc) and system-related factors (theater availability and standardized pathways). Readmission occurred for wound infection, wound hematoma and minor bleeding. Patient satisfaction rates were high (59.4% to 91.2%). Conclusions: Day-case appendicectomies are safe and achievable with robust patient selection criteria, clear pathways and improvements in theater availability and education of staff and patients. Clear guidelines are required with standardized care pathways to safely achieve day-case discharge of patients after appendicectomy.