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Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis
Jiyoung Shin, Myong Hoon Ihn, Kyung Sik Kim, Sang Hyun Kim, Jihyoun Lee, Sangchul Yun, Sung Woo Cho
Ann Coloproctol. 2023;39(1):50-58.   Published online November 18, 2021
DOI: https://doi.org/10.3393/ac.2021.00773.0110
  • 7,464 View
  • 173 Download
  • 3 Web of Science
  • 4 Citations
AbstractAbstract PDFSupplementary Material
Purpose
We sought to identify the risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis.
Methods
The study retrospectively analyzed 497 patients who underwent laparoscopic appendectomies for uncomplicated appendicitis between January 2018 and December 2020. The patients were divided into an early discharge group (≤2 days) and a late discharge group (>2 days) based on the length of hospital stay (LOS). The patients were also divided into uneventful and complicated groups according to the need for additional treatment after standard follow-up.
Results
Thirty-seven patients (7.4%) were included in the late discharge group. The mean LOS of the late discharge groups was 3.9 days. There were significant differences according to age, preoperative C-reactive protein (CRP), and operative time between the 2 groups. Only operative time was significantly associated with prolonged LOS in multivariate analysis. Thirty-five patients (7.0%) were included in the complicated group. The mean duration of treatment in the uneventful and complicated groups was 7.4 and 25.3 days, respectively. Significant differences existed between the uneventful and complicated groups in preoperative body temperature, preoperative CRP levels, maximal appendix diameter, and the presence of appendicoliths. In multivariate analysis, preoperative CRP levels and maximal appendix diameter were independent predictors of delayed treatment completion.
Conclusion
Shorter operative time is desirable to ensure minimal hospital stay in patients with uncomplicated appendicitis. Further efforts are needed to ensure that patients with uncomplicated appendicitis do not experience delayed treatment completion after laparoscopic appendectomies.

Citations

Citations to this article as recorded by  
  • Association between preoperative neutrophil-to-lymphocyte ratio and length of stay in pediatric patients undergoing laparoscopic appendectomy: a retrospective cohort study
    Ming Liu, Yunpeng Gou, Ping Yang
    BMC Pediatrics.2025;[Epub]     CrossRef
  • Comparative Outcomes of Immediate and Delayed Wound Closure Techniques in Appendectomies for Gangrenous Appendicitis
    Anzar Usman, Esha Akbar, Aliha Mukhtar, Iqra Nasir, Usama Rehman, Adil Iqbal, Muhammad Umar Umar
    DEVELOPMENTAL MEDICO-LIFE-SCIENCES.2024; 1(3): 18.     CrossRef
  • Non-linear association between C-reactive protein levels and length of stay in pediatric appendicitis patients undergoing laparoscopic appendectomy
    Ming Liu, Ping Yang, Yunpeng Gou
    Frontiers in Pediatrics.2024;[Epub]     CrossRef
  • Nomogram prediction model for length of hospital stay following laparoscopic appendectomy in pediatric patients: a retrospective study
    Ming Liu, Ping Yang, Yunpeng Gou, Qiang Chen, Dong Xu
    Frontiers in Pediatrics.2024;[Epub]     CrossRef
Benign GI diease
Resident Learning Curve for Laparoscopic Appendectomy According to Seniority
Chang Woo Kim, Sook Young Jeon, Bomina Paik, Jun Woo Bong, Sang Hyun Kim, Suk-Hwan Lee
Ann Coloproctol. 2020;36(3):163-171.   Published online February 14, 2020
DOI: https://doi.org/10.3393/ac.2019.07.20
  • 6,051 View
  • 129 Download
  • 12 Web of Science
  • 11 Citations
AbstractAbstract PDF
Purpose
To delineate the learning curve (LC) for laparoscopic appendectomy (LA) performed by residents according to seniority in training.
Methods
Between October 2015 and November 2016, 150 patients underwent LA by three residents (in their first, second, and third year of training) under supervision. The patients were non-randomly assigned to each resident. The data were reviewed and analyzed retrospectively from prospectively collected database. The perioperative outcomes were compared between the three residents including operation time, complication, conversion, and so on. The LCs were evaluated by the moving average method and cumulative sum control chart (CUSUM) for operation time and surgical completion.
Results
Baseline characteristics and perioperative outcomes were similar except for age and location of the appendix among the three groups. Operation time was not different among the three residents (43.9, 45.3, and 48.4 min for A, B, and C, respectively). The moving average method for operation time showed a decreasing tendency for all residents. CUSUM for operation time showed that the peak points occurred at the 24th, 18th, and 31st cases for resident A, B, and C, respectively. In terms of surgical failure, residents A, B, and C reached steady states after the 35th, 11th, and 16th cases, respectively. Perforation of the appendix base was the only risk factor for surgical failure.
Conclusion
The LC for LA by residents was 11-35 cases according to multidimensional statistical analyses. The accumulation of surgical experience of residents might affect the LC, especially for surgical completion rather than for operation time.

Citations

Citations to this article as recorded by  
  • Comparative analysis of surgical outcomes of laparoscopic appendectomy performed by six surgeons with different subspecialties: a retrospective cohort study using risk-adjusted cumulative summation
    Ji Hyeong Song, Inyoung Na, Song-Yi Kim, Youn Ju Lee, Sun Jong Han, Sang Il Youn, Sa-Hong Min, Jin Soo Kim
    Annals of Surgical Treatment and Research.2025; 109(3): 207.     CrossRef
  • The Influence of Surgical Teaching on Laparoscopic Cholecystectomy Outcomes: A Retrospective Propensity Score-Matched National Cohort Study
    Joana Rodrigues Ribeiro, André Silva Alves, Pascal Probst, Samuel A. Käser, Christian Toso, Beat Moeckli
    Journal of Surgical Education.2025; 82(11): 103744.     CrossRef
  • Systematic review and meta-analysis comparing perioperative outcomes of emergency appendectomy performed by trainee vs trained surgeon
    Theophilus TK. Anyomih, Thomas Jennings, Alok Mehta, J Robert O'Neill, Ioanna Panagiotopoulou, Stavros Gourgiotis, Elizabeth Tweedle, John Bennett, R Justin Davies, Constantinos Simillis
    The American Journal of Surgery.2023; 225(1): 168.     CrossRef
  • Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study
    Nathalie Young, Rebecka Ahl Hulme, Maximilian Peter Forssten, Lewis Jay Kaplan, Thomas Noel Walsh, Yang Cao, Shahin Mohseni, Gary Alan Bass, Alan Biloslavo, Hayato Kurihara, Isidro Martinez-Casas, Jorge Pereira, Arvid Pourlotfi, Éanna J. Ryan, Matti Tolon
    European Journal of Trauma and Emergency Surgery.2023; 49(1): 33.     CrossRef
  • Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper
    Nicola de’Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chiri
    World Journal of Emergency Surgery.2023;[Epub]     CrossRef
  • How does the number of training years in pediatric surgery affect appendectomy outcomes?
    Carlos Delgado-Miguel, Miriam Miguel-Ferrero, María San Basilio, Carla Ramírez, Juan Camps, Francisco Hernández Oliveros
    Pediatric Surgery International.2023;[Epub]     CrossRef
  • Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature
    Seokwon Kim, Byong Ho Jeon, Sang Sik Cho, Ui Sup Shin, Sun Mi Moon
    Annals of Coloproctology.2022; 38(2): 160.     CrossRef
  • Laparoscopic appendicectomy without the use of disposable materials - a low-cost alternative - 1,552 cases operated in 20 years
    CARLOS EDUARDO DOMENE, PAULA VOLPE, ANDRÉ VALENTE SANTANA
    Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub]     CrossRef
  • Learning curve in laparoscopic appendectomy: training strategy of laparoscopic surgery
    Hyung Ook Kim
    Annals of Coloproctology.2022; 38(3): 276.     CrossRef
  • Factors Influencing the Difficulty and Need for External Help during Laparoscopic Appendectomy: Analysis of 485 Procedures from the Resident-1 Multicentre Trial
    Stefano Cioffi, Andrea Spota, Michele Altomare, Stefano Granieri, Roberto Bini, Francesco Virdis, Federica Renzi, Elisa Reitano, Osvaldo Chiara, Stefania Cimbanassi
    Journal of Personalized Medicine.2022; 12(11): 1904.     CrossRef
  • Impact of COVID-19 on the care of acute appendicitis: a single-center experience in Korea
    Chang Woo Kim, Suk-Hwan Lee
    Annals of Surgical Treatment and Research.2021; 101(4): 240.     CrossRef
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