• Magalie Lefrancois, Jérémie H Lefevre, Najim Chafai, Sophie Pitel, Laure Kerger, Julie Agostini, Guillaume Canard, and Emmanuel Tiret.
• From the Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, University Paris VI (Pierre and Marie Curie), Paris, France.
• Ann. Surg. 2015 Jun 1; 261 (6): 1167-72.

ObjectiveEstablish a protocol of management of acute appendicitis (AA) in ambulatory surgery (AmbSurg) on the basis of preoperative criteria.BackgroundAmbulatory laparoscopic appendectomy (LA) for AA has not been yet reported.MethodsAll patients who underwent LA between 2010 and 2012 were reviewed. A multivariate analysis was performed to create a predictive score of discharge within the first 24 hours. The score was prospectively used on every AA from January 1, 2013, to December 15, 2013. All patients with 5 or 4 points were proposed for AmbSurg.ResultsA total of 468 patients were included retrospectively, 181(38.7%) were discharged within the first 24 hours. In multivariate analysis, predictive factors of early discharge were body mass index less than 28 kg/m, white cell count less than 15,000/mL, C-reactive protein less than 30 mg/L, no radiological signs of perforation, and appendix diameter of 10 mm or smaller. Rate of discharge at day 1 was 72%, 45%, 39%, 21%, 0%, and 0% according to the score 5 to 0 (P < 0.0001). Prospectively, 184 patients had AA and 103 (56%) had a score of 4 or 5. Thirty-eight underwent ambulatory LA [16 (42%) patients were postponed to the next day and went back home]. All patients were directly discharged from recovery room, except 1 (2.6%) patient, after a mean hospital stay of 8.4 hours ± 6.9 hours. A total of 146 patients underwent LA in conventional surgery and 58% were discharged at day 1. Rate of early discharge was significantly associated with the score ranging from 0% to 92% for a score 0 or 5, validating prospectively the score (P < 0.0001).ConclusionsWe establish a simple validated predictive score of early discharge. When applied to AmbSurg, it allowed us to select patients eligible with a success rate of 97%.

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