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Day Case Open Appendectomy: A Safe and Cost-Effective Procedure
Day Case Open Appendectomy: A Safe and Cost-Effective Procedure
2003
Faruk H. Faraj
College Of Medicine, Sulaimani University.
Sulaimani. Kurdistan Region of Iraq
Abstract
The aims of this prospective study are ;to evaluates the feasibility, safety, patient satisfaction
and cost-effectiveness of open appendectomy (OA) as a day case procedure. This study was done
in the accident and emergency department of Sulaimani teaching hospital (STH), Sulaimani,
Iraq, from June 1999 through September 2000. There were 170 cases of conventional, open
appendectomy, fifty cases of normal appendix or complicated appendicitis were excluded from
the study. The remaining cases selected with non-perforated acute appendicitis and randomized
into two group .The 1st group was offered to have day case appendectomy, (group DA), 60 cases.
The second group; the control group, also 60 case, appendectomy done for them as
conventional, inpatient procedure (group IA). Both groups were similar in number regarding
the age, gender, weight, fever and leukocytosis.
The age range was 5-50 Y with the mean age of 22Y, and male: female of 1.14:1. The mean
length of hospital stay (LOS) was shorter for patients in group DA (7 hours vs. 28.9h). There
was no significant difference in the incidence of postoperative morbidity. Patient satisfaction
was 98.3% in group DA, while it was 41.5 % for group IA. There were no readmission cases for
day surgery appendectomy cases . The average intra-hospital cost, apart from operation and
theatre cost, for day case was 175 I.D, while for group IA cases was 725 I.D. We conclude that
Appendectomy as a day case surgery is a feasible, safe and cost-effective procedure and the
patient satisfaction is excellent.
Introduction
The explosive growth of day The aims of this randomized, prospective
surgery, with a positive effects on study are ; to evaluate the feasibility of
patient care, is multifactor. The open appendectomy as a day case
factors are: Advances in surgery procedure, to study the outcome of this
including the development of method regarding its safety, length of
minimally invasive surgery. Advances hospital stay, morbidity, patient
in anesthetics. The cost-savings satisfaction and cost-effectiveness.
achieved by hospital managers, the
surgeons concern and patients Patients and methods-
awareness of quality assurance [1]. This is a randomized, controlled trial
The hospital inpatient charge reflects the study of 170 cases with suspected
costs of a number of functions associated appendicitis. They were operated by
with early convalescence in the hospital, open appendectomy in our 5th surgical
including nursing, diet and unit, in A& E department of Sulaimani
housekeeping.[2] teaching hospital(STH) from June 1999
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Table2 shows the age while it was 725.0 I.D in the other
distribution(Years) of appendicitis in group.
each group in this study: Statistical methods : the LOS and the
costs in both groups:
Table 2: Table 5 shows the means and standard
deviations of the traits studied:
Grou 1 -10 11- 21- 31- 41-50 Table 5
p 20 30 40 LOS COST
1(DA) 3 24 22 8 3 Col.1 Col.2 Col.3 Col.4
2(IA) 3 25 22 7 3 Count 60 60 60 60
Average 7 28.9333 175 725 I.D
In both groups, there were 32males and St. 1.1717 29.2925 198.191
Deviat 63.3853
28 females with male to female ratio of
1.14:1
Table 3 shows the occupations of the The computed P-value of LOS was less
patients in each group: than 0.05, indicating significant
difference between the two groups, and
Table 3 of the cost was less than 0.05(P<0.05)
Group H Pupils Free Regular indicating significant difference
ous & jobs office- between the two groups, too.
e- studen jobs Three cases (5%) in the group DA
wife ts developed minor wound infection and,
1(DA) 17 20 13 10 while 5 cases (8.3 %) in the group IA
2(IA) 16 22 12 10
developed wound infection .
All the infected cases were dealt with
Body mass index(BMI) were between in the outpatient clinic and the
18.5-24.9 which is within acceptable readmission rate was zero.
range [6], and comparable in both Table 5 shows the effects of
groups. environmental factor, acting as a
Table 4 shows the leukocyte count in barrier or facilitator ,on the patient
each group: satisfaction.
Table 4 Table 5
Group WBC 7000- WBC >
10,000/ ml 10,000/ml No. of QW Coding
1(DA) 5 cases 55 cases cases
2(IA) 6 cases 54 cases DA 59 No barrier 0-4% (0)
1 Mild barrier 5-24% (1)
IA 25 Mild Barrier 5-24% (1)
The body temperature in both groups 15 Moderate = 25-49%(2)
ranged from 37.5 to 38.7, as cases of 20 Severe = 50-95%(3)
perforated appendicitis excluded in this
study. Discussion
The LOS in day case surgery, group Acute appendicitis (A.A) is the most
DA, ranges from 5-9h with an average common cause of acute non-traumatic
of 7 hours, while in group IA ranged surgical abdomen in Sulaimani area[7]
from 20-48 hours with an average of . It is common in the developing
28.9h. countries and Irish people [8-10,].It is
The average intra-hospital cost of day less common than non-specific
case appendectomy was 175.0 I.D,
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ان اهداف هذه الدراسة هي لبيان امكانية اجراء عملية رفع الزائدة الدودية
كجراحة يومية ومدى ارتياح المرضى لها والفوائد القتصادية من هذه عملية ,
اجرى هذا البحث في قسم الطوارىء للمستشفي التعليمي في السليمانية خلل
فترة حزيران 1999لغاية ايلول 2000وشمل 170مريضا ادخلوا المستشفي
كحالت التهاب الزائدة الدودية .وتم اجراء عملية رفع الزائدة الدودية بطريقة
مفتوحة واختير 120حالة من حالت التهاب الزائدة الدودية في هذه الدراسة .تمت
تقسيم المرضى الى مجموعتين ,كل مجموعة شملت 60مريضا وان المجموعة
الولى عولجوا كجراحة يومية بينما المجموعة الثانية كحالت اعتيادية تقليدية وابقوا
في المستشفي لمدة يوم اواكثر .وان المجموعتين كانتا متشابهتين من حيث
العمار والجنس والوزن ودرجة حرارة الجسم وعدد الكريات الدم البيضاء ,ان
اهم المقايس في هذه الدراسة كانت مدة البقاء في المستشفى ,رضاء المرضى
ومضاعفات العملية وكلفة ومصاريف العملية .كانت العمار تتراوح بين 50-5سنة
ومعدل العمر كان 22سنة ونسبة الدكور الى الناث 1: 1,14ومعدل مدة البقاء في
المستشفى كانت اقصر في المجموعة الولى 7 (,ساعات مقابل 28,9ساعات) ,
ولم تكن هنالك اختلف احصائى مهم في نسبة المضاعفات في المجموعتين وان
نسبة الرتياح وقبول المرضي في المجموعة الولى لهذه الطريقة كانت % 98,3
بينما كانت % 41,5في المجموعة الثانية ولم تكن هناك حالت دخول ثانية بعد
اخراج الرضى من المستشفى وان معدل المصاريف وكلفة العملية ,عدى تكاليف
صالة العمليات ,في المجموعة الولى كان 175دينارا مقابل 725دينارا للمجموعة
الثانية ,وتبين في هذه الدراسة ان اجراء عملية رفع الزائدة الدودية كجراحة يومية
عملية ممكينة ,سليمة وامينة واقتصادية ,اقل كلفة من الطريقة التقليدية للدولة,
وان نسبة ارتياح المرضى لهذه الطريقة عالية لذا نوصى باجراء رفع الزائدة
الدودية باسلوب الجراحة اليومية بدل من الطريقة التقليدية لحالت التهاب الزائدة
الدودية الغير معقدة لسباب انفة ذكرها.
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