Outpatient laparoscopic appendectomy found safe, cost saving

This is a well-written paper that continues a series of contributions from the authors addressing management of acute appendicitis. A 1994 paper from the authors prospectively compared laparoscopic with open appendectomy. In 2012, the authors reported and described their protocol for outpatient management of laparoscopic appendectomy, comparing 116 patients with a matched historical cohort group. This paper is an update of the 2012 paper and now includes 345 patients.

They assume that their patients are at home, happy, and doing well after discharge. They may not be. The conclusions would be more valid if patients had completed a questionnaire that stated that they were home and doing well, as other authors have done in studying this disease.

The report provides mean times from the emergency department to the operating room and from completion of surgery to discharge. Median times would be helpful to know.

I congratulate them on a well-presented and well-written paper.

Dr. Andrew Peitzman is professor of surgery and chief of general surgery and of trauma/surgical critical care at the University of Pittsburgh. He gave these comments as the discussant of Dr. Frazee’s study at the meeting.