Emergency appendicectomy in the era of EWTD : a one-year audit

Aim : We aimed to audit our surgical practice of emergency laparoscopic appendicectomy in the post-EWTD era in accordance to the 2005 clinical guidelines formulated by the Royal College of Surgeons in Ireland for acute appendicitis. Methods : Data was collected for all patients who underwent open and laparoscopic appendicectomy for uncomplicated appendicitis between January to December 2010 by manually searching all operative and pathology records retrospectively. Results: A total of 147 patients were analysed, 69 in the laparoscopic and 78 in the open group. The median length of stay in hospital in the laparoscopic group was 2.56 days and 2.18 days in the open group. A total of 9 (6.1%) readmissions were recorded from both groups of which 6 (8.6%) were seen in laparoscopic and 3 (3.8%) in the open group ( p = 0.37). The average time to re-admission was recorded at 20.6 days (range of 1-31) in laparoscopic and 3.6 days (range of 1-7 days) in the open group ( p = 0.15). There were no technique related complications to report from either group. The normal appendicectomy rate was found to be 52.1% (n=36/69) in laparoscopic group compared to 20.5 % (n=16/78) in the open group. Conclusion: The median length of stay in both the groups was similar ( p =0.15). Adhering to the Royal College clinical guidance, surgical trainees (ST3 and above) performed 54.4% (n=80) appendicectomy operations, of which 47.5% (n=38) were laparoscopic and 52.5% (n= 42) were open procedures. Both EWTD and competency based training had no impacts on the number of laparoscopic appendicectomies performed. The findings of low rate of out-of-hours laparoscopic appendicectomies (26%) highlighted from our audit led to education and training of our emergency staff in management protocols.