Quicker recovery after laparoscopic appendectomy cuts productivity loss

Laparoscopic appendectomy (LA) patients generally do not need to undergo 2 weeks of analgesics, leading to shorter hospitalization leaves (HL) and to a faster return to work, according to a recent Singapore study.

“The majority of LA patients do not need 2 weeks of analgesics and their HL can be shortened for faster return to work, thereby realizing the true benefits of minimally invasive surgery,” the researchers said.

The retrospective study included 201 patients whose emergency appendectomies were audited for the outcomes of postoperative pain, length of stay (LOS), analgesia duration, and HL. Phone interviews were used to assess postdischarge residual symptoms and analgesic intake, as well as patient opinions of teleconsult reviews.

Majority (93 percent; n=187) of the patients underwent laparoscopic procedures. Overall, average postoperative pain scores were higher in those who received open appendectomy (OA) vs LA, though the difference did not reach statistical significance (4.14 vs 3.60; p=0.068). Mean LOS, on the other hand, was significantly shorter in the LA group (3.09 vs 6.93; p=0.005). [JSLS 2022;26:e2022.00006]

A total of 152 patients agreed to accomplish the follow-up phone interview, yielding a response rate of 76 percent. Of these, more than half (59 percent) took their prescribed analgesics for less than 5 days. Meanwhile, 83 percent said that they did not need analgesic agents for more than 7 days.

Nevertheless, in terms of average HL, LA patients were granted significantly shorter leaves than OA counterparts (17.9 vs 21.8 days; p=0.05). Ultimately, 36 LA patients had to request that they be assigned to light duties due to the strenuous nature of their jobs, as opposed to only three OA counterparts.

Overall, it took an average of 45.7 days before LA patients could fully return to work, as compared with 68.7 days in the OA group (p=0.235).

Analgesic requirement, duration of hospitalization, work leaves, and adjustments in workload did not differ according to ethnicity.

“As there were very few OA patients, it is difficult to make any meaningful comparisons of pain scores in our study, though intuitively laparoscopic procedures would have less pain,” the researchers said. “The purpose of this study was to show that the duration of analgesics prescribed was excessive based on pain scores for the LA group and patient responses in the telephone survey.”

“The survey showed that nearly 83 percent of the patients did not complete the prescribed 2-week duration of analgesics with 59.21 percent taking them for less than 5 days. This clearly shows that blindly prescribing a 2-week course of analgesics for all patients is not necessary and analgesia dosage needs to be tailored down,” they added.