Randomized clinical trial to compare the length of hospital stay and morbidity for early feeding with opioid-sparing analgesia versus traditional care after open appendectomy.

Background & Aims: Fast track protocols have been successfully used in abdominal surgery but there are no randomized trials on fast track after appendectomy. The aim of this study was to evaluate the safety and feasibility of fast track perioperative care protocol including early feeding with opioid-sparing analgesia after open appendectomy.

Methods: We randomly allocated 62 consecutive patients who underwent appendectomy to an early feeding with opioid-sparing analgesia and traditional care group. The study was not blinded regarding the mode of postoperative rehabilitation. Clinical primary endpoint was length of postoperative hospital stay. Secondary endpoints were morbidity rate, time to bowel sounds and passage of flatus or stools, tolerance of solid diet and facial visual pain score.

Results: The mean length of primary hospital stay was significantly shorter in the early feeding with opioid-sparing analgesia than in traditional care group (2.2 versus 4.0 days, P<0.001). No significant differences were seen between groups regarding demographics, degree of pathological changes in the appendix, and in the secondary endpoints such as morbidity, frequency of vomiting, visual facial pain score, time to first flatus or stools, resumption of bowel sounds and toleration of solid diet.

Conclusions: This study indicates that early feeding and opioid-sparing analgesia after open appendectomy is safe and reduces length of hospital stay without deterioration of pain control.