Enhanced recovery through fast-track pathway for patients undergoing emergency appendectomy: a quality improvement study

Abstract

Introduction: Acute appendicitis is a highly prevalent condition, with an incidence ranging from 5.7 to 57 cases per 100,000 inhabitants per year. The average hospitalization duration for patients undergoing laparoscopic appendectomy is 2.08 days and 2.88 days for open appendectomy cases. The implementation of Enhanced Recovery After Surgery (ERAS) protocols for early patient recovery reduces hospital stay without an increase in complications or readmissions. The main objective of the study is to analyze the postoperative hospital stay in patients undergoing urgent appendectomy (open or laparoscopic) who follow the clinical pathway included in the ERAS bundle.

Materials and methods: Prospective observational study conducted at the Hospital Universitari Parc Taulí, in Sabadell (Barcelona). The results of the patients included in the study were compared with the historical cohort of the hospital with inclusion criteria identical to the study.

Results: Between May 2021 and February 2022, 50 patients (24 men and 26 women) were included. Laparoscopic appendectomy was performed in 47 patients and open appendectomy in 3 cases. The mean postoperative stay in the group that followed the clinical pathway was 23 hours, compared to 38 hours in the historical control group, with this difference being statistically significant (p 0.03), without observing an increase in morbidity.

Conclusion: The use of clinical pathways in patients undergoing urgent surgery for acute appendicitis reduces the average hospital stay without increasing the risk of complications or readmissions.