S. G. Thrumurthy1, R. Som1 1King’s College Hospital NHS Foundation Trust,Surgery,London, London, United Kingdom
Introduction:
Appendicectomy remains one of the most commonly performed emergency surgical operations, and postoperative recovery is influenced by various patient-related and technical factors. This prospective study aimed to identify how such factors affect the incidence of complications and the extent of symptom resolution after emergency appendicectomy.
Methods:
Patients who underwent emergency appendicectomy over a six month period were contacted by telephone. A standardised questionnaire was used to ascertain the duration of analgesia use, duration before return to normal physical activity, duration before return to work or school, surgical site infection rates, rates of re-presentation to community physicians or the emergency department, and rates of readmission to hospital. Patients were stratified into those who underwent laparoscopic versus open appendicectomy, smokers verses non-smokers, and body mass index (BMI) < 30 versus BMI > 30.
Results:
A total of 145 patients were included. Patients undergoing open surgery (versus laparoscopic surgery) required analgesia for significantly longer periods (22 days v. 6 days, p = 0.017), and a longer recovery period before full return to normal daily activities (48 days v. 17 days, p < 0.0001) and school/work (33 days v. 13 days, p < 0.0001). Compared to non-smokers, smokers required longer a recovery period before returning to school/work (24 days v. 17 days, p = 0.048), had a significantly higher risk of surgical site infection (relative risk [RR] 2.21, p = 0.029), and a higher risk of re-presenting to the emergency department (RR 3.21, p = 0.003) and being re-admitted to hospital within 3 months of surgery (RR 8.36, p = 0.002). Compared to patients with a BMI under 30, those with a BMI over 30 had a longer recovery period before full return to normal daily activities (49 days v. 24 days, p = 0.041) and school/work (26 days v. 17 days, p = 0.016), a higher rate of surgical site infection (RR 2.13, p = 0.044), and a higher risk of re-presenting to the emergency department (RR 3.09, p = 0.005) and being re-admitted to hospital within 3 months of surgery (RR 6.0, p = 0.008).
Conclusion:
When possible, the laparoscopic approach to appendicectomy should be adopted over open surgery to improve postoperative recovery. Patients who are smokers or obese (BMI > 30) should be warned of prolonged recovery times, and surgeons must be wary that such patients are at greater risk of surgical site infections and needing emergent or inpatient care for postoperative complications. Such patient groups may benefit from early postoperative outpatient follow-up.