Principles of safe day case appendicectomy and patient satisfaction rates: a systematic review
Author(s)
Tase, Arkeliana
Akari, Alan
Type
Journal Article
Abstract
Introduction
Acute appendicitis is one of the most common surgical pathologies. Whilst literature reports safe day-case appendicectomies in uncomplicated cases, hesitancy exists in discharging patients on the day of surgery. This study addresses the criteria for day-case surgery, patient selection, reported clinical risks vs benefits, complications, rates of readmission and patient satisfaction.
Methods
A literature review was carried out in Pubmed and Medline for day-case appendicectomy, patient safety, day case surgery and NHS. British Association of Day Surgery recommendations were reviewed in relation to appendicectomy as a day-case.
Results
From the 146 identified papers, 19 fulfilled the inclusion criteria. Variability was noted in definition of same-day discharge. Included patients had uncomplicated appendicitis, post-operative pain well managed by non-opioid analgesia, no clinical concerns and care at home. Age under 65yrs, ASA 1 or 2, absence of insulin dependent diabetes and immunosuppressant therapy were also part of the inclusion criteria. No statistically significant difference was found in rates of reintervention and reoperation between admitted and discharged patients. Reasons for overnight admission were due to patient (age, comorbidities etc.) and system related factors (theatre availability and standardised pathways). Readmission occurred for wound infection, wound haematoma and minor bleeding. Patient satisfaction rates were high (59.4% to 91.2%.).
Conclusions
Day case appendicectomies are safe and achievable with a robust patient selection criteria, clear pathways and improvements in theatre availability and education of staff and patients. Clear guidelines are required with standardised care pathways to safely achieve day case discharge of patients after appendicectomy.
Acute appendicitis is one of the most common surgical pathologies. Whilst literature reports safe day-case appendicectomies in uncomplicated cases, hesitancy exists in discharging patients on the day of surgery. This study addresses the criteria for day-case surgery, patient selection, reported clinical risks vs benefits, complications, rates of readmission and patient satisfaction.
Methods
A literature review was carried out in Pubmed and Medline for day-case appendicectomy, patient safety, day case surgery and NHS. British Association of Day Surgery recommendations were reviewed in relation to appendicectomy as a day-case.
Results
From the 146 identified papers, 19 fulfilled the inclusion criteria. Variability was noted in definition of same-day discharge. Included patients had uncomplicated appendicitis, post-operative pain well managed by non-opioid analgesia, no clinical concerns and care at home. Age under 65yrs, ASA 1 or 2, absence of insulin dependent diabetes and immunosuppressant therapy were also part of the inclusion criteria. No statistically significant difference was found in rates of reintervention and reoperation between admitted and discharged patients. Reasons for overnight admission were due to patient (age, comorbidities etc.) and system related factors (theatre availability and standardised pathways). Readmission occurred for wound infection, wound haematoma and minor bleeding. Patient satisfaction rates were high (59.4% to 91.2%.).
Conclusions
Day case appendicectomies are safe and achievable with a robust patient selection criteria, clear pathways and improvements in theatre availability and education of staff and patients. Clear guidelines are required with standardised care pathways to safely achieve day case discharge of patients after appendicectomy.
Date Issued
2026-08-13
Date Acceptance
2026-06-14
Citation
BMJ Trauma Surgery & Acute Care Open, 2026
ISSN
2397-5776
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Trauma Surgery & Acute Care Open
Copyright Statement
Copyright This paper is embargoed until publication. Once published the author’s accepted manuscript will be made available under a CC-BY License in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy).
License URL
Subjects
Day case surgery, appendicectomy, criteria for day case appendicectomy, selection criteria, same day discharge
Publication Status
Accepted