(KAJ)Kurdistan Academician Journal , Sept 2003 , 2(1) Part A, (1-8) 8 -1 ( ) A

2003

Day Case Open Appendectomy: A Safe

and Cost-Effective Procedure

Faruk H. Faraj
College Of Medicine, Sulaimani University.
Sulaimani. Kurdistan Region of Iraq

Abstract
The aims of this prospective study are ;to evaluates the feasibility, safety, patient satisfaction
and cost-effectiveness of open appendectomy (OA) as a day case procedure. This study was done
in the accident and emergency department of Sulaimani teaching hospital (STH), Sulaimani,
Iraq, from June 1999 through September 2000. There were 170 cases of conventional, open
appendectomy, fifty cases of normal appendix or complicated appendicitis were excluded from
the study. The remaining cases selected with non-perforated acute appendicitis and randomized
into two group .The 1st group was offered to have day case appendectomy, (group DA), 60 cases.
The second group; the control group, also 60 case, appendectomy done for them as
conventional, inpatient procedure (group IA). Both groups were similar in number regarding
the age, gender, weight, fever and leukocytosis.
The age range was 5-50 Y with the mean age of 22Y, and male: female of 1.14:1. The mean
length of hospital stay (LOS) was shorter for patients in group DA (7 hours vs. 28.9h). There
was no significant difference in the incidence of postoperative morbidity. Patient satisfaction
was 98.3% in group DA, while it was 41.5 % for group IA. There were no readmission cases for
day surgery appendectomy cases . The average intra-hospital cost, apart from operation and
theatre cost, for day case was 175 I.D, while for group IA cases was 725 I.D. We conclude that
Appendectomy as a day case surgery is a feasible, safe and cost-effective procedure and the
patient satisfaction is excellent.

Keywords:-F.H.Faraj, Day case Surgery, Acute Appendicitis.

Introduction
The explosive growth of day The aims of this randomized, prospective
surgery, with a positive effects on study are ; to evaluate the feasibility of
patient care, is multifactor. The open appendectomy as a day case
factors are: Advances in surgery procedure, to study the outcome of this
including the development of method regarding its safety, length of
minimally invasive surgery. Advances hospital stay, morbidity, patient
in anesthetics. The cost-savings satisfaction and cost-effectiveness.
achieved by hospital managers, the
surgeons concern and patients Patients and methods-
awareness of quality assurance [1]. This is a randomized, controlled trial
The hospital inpatient charge reflects the study of 170 cases with suspected
costs of a number of functions associated appendicitis. They were operated by
with early convalescence in the hospital, open appendectomy in our 5th surgical
including nursing, diet and unit, in A& E department of Sulaimani
housekeeping.[2] teaching hospital(STH) from June 1999

1
(KAJ)Kurdistan Academician Journal , Sept 2003 , 2(1) Part A, (1-8) 8 -1 ( ) A
2003

through Sept 2000. Fifty cases with

normal appendix or complicated Postoperatively, they received the same
appendicitis were excluded from this analgesic, and postoperative care which
study. The remaining cases with non- inclues ; Diclofenac i.m as analgesia
perforated acute appendicitis were and 1 pint fluid (glucose/saline) .
selected. These cases were randomized Discharge was allowed when the
into two groups, each 60 cases. Group patient was drinking or eating liquid
1, was operated upon as day surgery diet, walking and bowel sound were
(group DA) and discharged from positive or passed flatus. Passage of
hospital in the same day while Group 2, stool is not required prior to discharge..
operated upon as conventional, The patients were followed-up in the
inpatient cases (group IA) with outpatient clinic of STH at 1 week, 2
overnight or more stay in the hospital. weeks, 4 weeks and 3 months . Data
Patients were selected for day collected were postoperative wound
treatment if they wanted to be infection rate, the readmission rate and
discharged same day. They were the costs, excluding intra-theatre costs.
selected according to medical and Environmental factor of ICF(
social criteria for day surgery [3] i.e International Classification of
they had no significant concomitant, Function) is used for assessment of
systemic illness, and according to patient satisfaction [5] .
ASA( American Society of Table 1 shows the negative and positive
Anesthsiology) was up to ASA II [4]. scale that denotes the extent to which
They were living in or in the vicinity of an environmental factor acts as a
the center of the city and if there was barrier or facilitator [5]:
an adult at home to look after them. Table 1
Data collected regarding age, sex, QW* Coding QW
occupation, body weight, residence, 0 No barrier 0-4 % 0 no facilitation
symptoms and their durations, fever, 1 mild = 5-24% +1 mild =
2 moderate 25-49% +2 moderate =
concomitant medical illness, abdominal barrier
findings, leukocyte counts and the 3 severe = 50-95% +3 substantial =
length of hospital stay (LOS). 4complete= 96- +4 complete =
Both groups were either similar or 100%
nearly so in number regarding the age,
gender, body built, occupation, fever * QW =Qualifying words.
and leukocytosis . They received the Regarding the cost and length of
same prophylactic antibiotic hospital stay(LOS)and cost; t-test was
preoperatively, Metronidazole 500 mg used for test of significance.
orally 2 h before surgery. The
appendices were similar in the gross Results
appearance , histopathological Patient’s characteristics-
examination of appendix, and operated The age ranges from 5-50 years with
upon by the same surgeon, using the the mean age of 22.2 Y for group 1 and
same operative procedure. 22.1 Y for group 2.

2
(KAJ)Kurdistan Academician Journal , Sept 2003 , 2(1) Part A, (1-8) 8 -1 ( ) A
2003

Table2 shows the age while it was 725.0 I.D in the other
distribution(Years) of appendicitis in group.
each group in this study: Statistical methods : the LOS and the
costs in both groups:
Table 2: Table 5 shows the means and standard
deviations of the traits studied:
Grou 1 -10 11- 21- 31- 41-50 Table 5
p 20 30 40 LOS COST
1(DA) 3 24 22 8 3 Col.1 Col.2 Col.3 Col.4
2(IA) 3 25 22 7 3 Count 60 60 60 60
Average 7 28.9333 175 725 I.D
In both groups, there were 32males and St. 1.1717 29.2925 198.191
Deviat 63.3853
28 females with male to female ratio of
1.14:1
Table 3 shows the occupations of the The computed P-value of LOS was less
patients in each group: than 0.05, indicating significant
difference between the two groups, and
Table 3 of the cost was less than 0.05(P<0.05)
Group H Pupils Free Regular indicating significant difference
ous & jobs office- between the two groups, too.
e- studen jobs Three cases (5%) in the group DA
wife ts developed minor wound infection and,
1(DA) 17 20 13 10 while 5 cases (8.3 %) in the group IA
2(IA) 16 22 12 10
developed wound infection .
All the infected cases were dealt with
Body mass index(BMI) were between in the outpatient clinic and the
18.5-24.9 which is within acceptable readmission rate was zero.
range [6], and comparable in both Table 5 shows the effects of
groups. environmental factor, acting as a
Table 4 shows the leukocyte count in barrier or facilitator ,on the patient
each group: satisfaction.
Table 4 Table 5
Group WBC 7000- WBC >
10,000/ ml 10,000/ml No. of QW Coding
1(DA) 5 cases 55 cases cases
2(IA) 6 cases 54 cases DA 59 No barrier 0-4% (0)
1 Mild barrier 5-24% (1)
IA 25 Mild Barrier 5-24% (1)
The body temperature in both groups 15 Moderate = 25-49%(2)
ranged from 37.5 to 38.7, as cases of 20 Severe = 50-95%(3)
perforated appendicitis excluded in this
study. Discussion
The LOS in day case surgery, group Acute appendicitis (A.A) is the most
DA, ranges from 5-9h with an average common cause of acute non-traumatic
of 7 hours, while in group IA ranged surgical abdomen in Sulaimani area[7]
from 20-48 hours with an average of . It is common in the developing
28.9h. countries and Irish people [8-10,].It is
The average intra-hospital cost of day less common than non-specific
case appendectomy was 175.0 I.D,

3
(KAJ)Kurdistan Academician Journal , Sept 2003 , 2(1) Part A, (1-8) 8 -1 (
2003
abdominal pain in developed countries
[11-13]. A.A is most common in the
second and third decades of life [7,11] ,
this is in agreement with our study ,
shown in table 2.
Appendectomy is the most common
emergency operation performed in the
accident and emergency hospital in our
locality and accounted for more than
2/3rd of all operated cases [7], like
elsewhere [8,9,11]. Therefore detecting
any new modality of treatment that will
affect the cost-effectiveness of this
common surgical procedure is worth
trying.
Preoperatively, prophylactic
metronidazole used as this drug proved
to be cost-effective elsewhere[14] .
They received one-pint fluid to
improve their recovery from general
anesthesia as proved by other
worker[15].
They received Diclofenac I.M as
analgesia, as post-operative pain may
be a significant cause for delay
discharge from hospital, increased
morbidity and reduced patient’s
satisfaction with day case surgery .
Diclofenac provides effective analgesia
and has more acceptable side effects
than morphine sulphate and is the
treatment of choice after day case
surgery as proved by other worker [16].
Statistical analysis revealed significant
difference between the LOS of the two
groups , as the P-value is <0.05,
indicating significant reduction in the
duration of hospitalization in the day
case group. In other studies, the LOS
varied between 1-8.6 days[17-24].
Statistical analysis revealed significant
difference in the hospital cost between
the two groups as the P<0.05,which is
due to a decrease in the mean duration
of hospital stay. If we consider the
4
) A
annual number of cases of
appendectomy which were performed
in our locality, (in 2000 e.g. in A&E
department, 1584 cases, and mean
number of 132 cases per month[7], we
can save 871200 I.D annually) .
The costs incurred by the patients or
their families is less in day cases as the
loss of income or hours off work and
the out of pocket expenses increases
with inpatient surgery as revealed in
Canadian study[25].
Three cases (5%) in group 1 (DA)
developed wound infection, while 5
cases (8.3%) in group 2 developed
wound infection with the P value of >
0.05 and this difference is statistically
insignificant .The rate of wound
infection in other studies including LA
: varies between 1.9-19%[26-,28].In
U.K study by OA for infection rates
was lower in pediatric group in
Edinburgh study and was 1.9% [ 26]
and our results were similar to those of
Schein et al study[27], Norwegian
study[ 28] and in both the wound
infection rate were 7%.
The readmission rate was nil in this
study .In a study in U.K by Johnson for
all day cases in general surgical
department the readmission rate was
0.7% and he concluded that day case
surgery is safe and should rarely be
followed by the need for hospital
admission, whereas there was
unavoidable cases as severe post-
operative pain or complicated cases
[29]
In the DA cases, 59 cases (98.3 %)
were very satisfied with the early
discharge in the same day of operation
and only one patient was dissatisfied as
he had minor wound infection, this was
attributed to the early discharge, while
only 25 cases (41.5%) in the other
(KAJ)Kurdistan Academician Journal , Sept 2003 , 2(1) Part A, (1-8) 8 -1 ( ) A
2003

group were satisfied with even short Acknowledgement

overnight or more stay in the hospital I am greatly thankful for Miss Awring
As it is unnecessary to perform M.A, from the secretary of higher
appendectomy in the middle of the education and Dr.Bahzad W.H. senior
night even in children [30], therefore house officer for their great help. I am
cases of uncomplicated AA presenting very thankful for Dr. Shawnim A.M, Ph
to A & E department in the late hours D Science and Mr. Nizar A. Ali Msc
of the night can be postponed for next Statistics for their great help.
day to be dealt with as day cases.
Conclusion- Open appendectomy as a
day case surgery is a feasible, safe,
cost-effective procedure with a good
outcome results and the patient
satisfaction is excellent . We
recommend it for non-perforated AA.

References
1-Scientific American Surgery. Growth of outpatient surgery. :3.Non-emergency
surgery II. Peri-operative issues and post-operative care. 1998 , 13-17.
2-Ambulatory Surgery .ACS Reports. American College Of Surgeons, Chicago,1983.
3-Jarrett PEM .Provision of a Day case Surgery Service.In:Johnson CD, Taylor
I,eds.recent Advances in Surgery, 17.Edinburg:Churchill Livingstone, 1994:49-64.
4-T. Cooke, G. Keogh. Preoperative preparation for surgery. Clinical surgery in
General .RCS course manual. ISBN o-443-04574-7. Churchill Livingsone.1993.
Ch.7.P 115-6
5-ICF. International Classification of functioning, disability and health. World health
organization (WHO) .Geneva. 2001.ISBN 92 41545 42 9. WHO library
Cataloguing- In- publication – Data. NLM Classification :W15 P 232-233
6-Needlman R.D. Assessment of growth. Nelson textbook of pediatrics.W.B.Saunders
company..ISBN 0-7216-5578-5 . 15th edition.1996. 16. 63-67.
7-.Faraj F.H. The pattern of acute abdomen in Sulaimany Teaching Hospital..
Journal Of Zankoy Sulaimani, Part –A 2000.3: 59-72
8-Datubo-Brown-DD; Adotey-JM. Pattern of Surgical acute abdomen in the
university of Port Hart court Teaching Hospital. West- Afr-J- Med.1990; 9(1):
59-62.
9-Kim-JP; Kim-SJ; Lee-JH. Surgery in aged in Korea. Arch-Surg 1998; 133(1):
18-23.
10-Davies-MG; Shine-MF; Lennon-F. Surgical emergencies in Ireland. An audit of
the emergency surgical caseload of an Irish district general hospital. Ir-J-Med-
Sci.1991; 160 (10): 303-6
11-Miethinen –P; Pasanen-P; Lathinen-J. Acute abdominal pain in adults.
Chir.Gynecol. 1996: 85(1): 5-9
12-TJO’ Kelly; ZH Krukowski. The acute abdomen. The journal of Surgery.1999.
17.242-251.
13-Hawthorn-JE; Abdominal pain as a cause of Acute admission to hospital.
J.R.Coll. Surg. Edinb. 1992 ; 37 (6): 389-93.

5
(KAJ)Kurdistan Academician Journal , Sept 2003 , 2(1) Part A, (1-8) 8 -1 ( ) A
2003

14-Banani- SA; Taki-A. Can oral Metronidazole substitute parentral drug Therapy In
AA? Am.J.Surg.1999 ; 65 (5): 411-6.
15-Cook-R; Anderson –S; Riseborough-M; Blogy-CE. Intravenous fluid load and
recovery. A double-blind comparison in gynecological patients who had day Case
laparoscopy. Anesthesia 1990; 45(10): 826-30.
16-Mc-Evoy-A; Livingstone-JI; Cahill-CJ. Comparison of Diclofenac and morphine
sulphate for post operative analgesia after day case inguinal Surgery.
Ann.R.Coll.Surg.England 1996 : 78 (4): 363-6.
17-Neilson-IR; Laberge-JM; Nguyen-LT; Moir-C; Doody-D. Appendicitis in
children. Current therapeutic recommendations. J-Pediatric Surg.1990 ; 25(11):
1113-6
18-DesGroseilliers –S; Fortin –M; Lokanathan-R; Khioury-N: Mutah-D.
Laparoscopic appendectomy versus open Appendectomy: Retrospective
assessment of 200 patients. Can. J.Surg. 1995 ;38 (2): 178-82.
19-Varlet- F; Tardieu-D; Limonne-B; Metafiot-H ; Chavrier-Y. Laparoscopic Versus
open appendectomy in children – Comparative study of 403 cases. Eur.J.Pediatr.
Surg. 1994; 4(6): 333-7
20-Sarfati-MR; Hunter-GC; Witzke-DB; Bebb-GC; Smythe –SH; Rappaport -WD.
Impact of adjunctive therapy on the Diagnosis and clinical course of patients with
AA. Am-J- Surg. 1993; 166(6): 660-4.
21-Mutter-D; Vix-M; Bui-A; Evrad –S; Tassetti –V; Breton-JF; Mare Scaux –J. Surg.
1996; 120 (1): 71-4.
22-Lord –RV; Sloane –DR. Early discharge After open appendectomy. Aust. N-Z-J-
Surg. 1996; 65 (6): 361-5.
23- Tarnoff-M; Atebek-U; Goodman-M; Alexander –JB; Chrzanoski-F; Mortman-
K; Camishon-R. A comparison of Laparoscopic and open appendectomy. J- Soc-
Laparoendosc-Surg.1998; (2) : 153-8.
24- Warner-BW; Kulick-RM; Stoops-MM; Mehta-S; Stephan-M; Kotagal-UR. An
evidenced – based clinical pathway for AA decreases hospital duration & cost. J-
Pediatr-Surg. 1998; 33 (9): 1371-5.
25-Stanwick-RS; Horner-JM; Peabody-DM ; Postum-R. Day case versus inpatient
Pediatric surgery. A comparison of costs Incurred by parents. Can-Med- Assoc- J.
1987 ; 137 (1): 21-6
26-Tsang-TM; Tam-PK; Saing-H. Antibiotic prophylaxis in acute non-perforated
Appendicitis in children – Single dose of Metronidazole & gentamycin. J-R-Coll-
Surg- Edinb. 1992 ; 37(2): 110-2
27-Schein-M; Assalia-A; Bachw-H. Minimal antibiotic therapy after emergency
abdominal surgery. A prospective study. Br-J-Surg.1994 ; 81(7): 989-91
28-Dahlstrom-Bl; Reiertsen-O; Rosseland – AR.Antibiotic prevention in Acute
Appendicitis. Tidsskr-Nor-Laegeforen. 1990 10; 110 (12): 1539-40
29-Johnson-CD; Jarrett-PE. Admission to hospital after day case surgery. Ann-R-
Coll- Surg-Edinb. 1999; 72(4): 225-8
30-Surana-R; Quinn-F; Puri-P. Is it necessary to perform appendectomy in the
middle of the night in children. BMJ. 1993 1; 306 (6886): 1168

6
‫( ‪(KAJ)Kurdistan Academician Journal , Sept 2003 , 2(1) Part A, (1-8) 8 -1‬‬ ‫)‬ ‫‪A‬‬
‫‪2003‬‬

‫–‬ ‫رِوَذانة‬ ‫لبردني رِيخوَل َ ة كويَرة بة نةشتةرطةري‬

‫ي كيَشةو ئابوورييانةية‬
‫نةشتةرطةريةكي ب َ‬
‫ف اروق حس ن ف رج‬

‫كؤليَجى ثزيشكى ‪ /‬زانكؤى سليَمانى ‪ /‬هةرِيَمى كوردستان‪ -‬عيَراق‬

‫لةروونكردنةوةي ئةوةي كة ئايا‬ ‫ِ‬ ‫ئامانجةكاني ئةم ليَكوّلَينةوةية بريتي ية‬

‫ئةتوانري َت رِيخوَل َة كويَرة لببري َت بةنةشتةرطةري رِوَذانة ؟وة ئةم كارة ضةندة‬
‫سةركوتووة و ضةند ثةسةندة بةلي نةخوَشةوة ؟ وةئايا لة بارةي ئابوريةوة‬
‫كةمتري تيَدةضيَت؟‬
‫ئةم ليَكوَلَينةوةية لةبةشي كتووثرِي نةخوَشخانةي سليَماني فيَركاري ئةنجام دراوة‬
‫لة حزيراني ‪ 1999‬تا ئةيلولي ‪ 2000‬لةسةر ‪ 170‬نةخو َش كة بةهةوكردني رِيخوَلة‬
‫ل بوون‪ ,‬لةمانة ‪ 120‬نةخو َش هةلَبذيَراون كة تووشي هةوكردني رِيخوَلَة كويَرة‬ ‫داخ َ‬
‫بوون نةشتةرطةري لبردني رِيخوَلَةكويَرةيان بة شيَوةي كراوة بوَئةنجام دراوة ‪.‬‬
‫نةخوَشةكان كراون بة دوو طرووثي ‪ 50‬كةسيةوة ‪ ,‬طروثي يةكةم نةشتةرطةري‬
‫كراوةي رِوَذانةيان بوَكراوة‪ ,‬هةردووطرووثةكة وةك يةك بوون لة تةمةن و‬
‫رةِطةزوو كي َ ش و ثلةي طةرمي لةشيان و ذمارةي خرِوَكة سثيةكانيان ‪,‬‬
‫طرنطترين ثيَوةر كةبةكارهاتووة لةم ليَكوَلَينةوةيةدا ئةمانةن‪:‬ماوةي مانةوة‬
‫لةنةخوَشخانة وةثةسةندكردني نةخوَ ش بوَئةم شيَوازةو ماكةكاني ئةم‬
‫نةشتةرطةرية ولةرِووي ئابوورييةو ضةند خةرجي دةوي َت ‪ .‬تةمةني نةخوَشةكان‬
‫ي ‪1: 1,14‬‬ ‫ل بوون‪ ,‬تيَكرِاي تةمةنيان ‪ 22‬سا َ‬
‫ل بوو رِيَذةي ني َر بو َ م َ‬ ‫لةنيَوان ‪ 50-5‬سا َ‬
‫وة تيَكرِاي مانةوةلة نةخوَشخانة كةمتربووة لة طروثي يةكةمدا (‪7‬كاتذميَر‬
‫بةرامبةر ‪ .) 28,9‬هةرضةندة رِيَذةي ماكةكاني (مضاعفات) كةمتر بووة لة طرووثي‬
‫يةكةمدا بةلم جياوازييةكي سةرذميَري طرنطيان لةنيَواندا نةبووة وة‬
‫لة طروثي يةكةمدا ‪ % 98,2‬بووة بةل َم لةطرووثي‬ ‫ثةسةندكردني نةخوَ ش‬
‫دووةمدا ‪ . % 41,5‬هيض نةخوَشي َ ك دووبارة نةطةرِاوةتةوة بوَ نةخوَشخانة وة‬
‫ي خةرجي نةشتةرطةريةكة) ‪175‬‬ ‫تيَكرِاي خةرجي نةخوَشةكاني طروثي يةكةم (ب َ‬
‫دينار بووة بةرامبةر ‪ 725‬دينار بووة لة نةخوَشي طروثي دووةمدا ‪,‬لةئةنجامي ئةم‬
‫ليَكوَلَينةوةيةدا بوَمان دةردةكةوي َ ت كةئةتوانري َ ت رِيخوَل َ ة كويَرة لببري َ ت بة‬
‫نةشتةرطةري كراوةي رِوَذانة وة ئةم نةشتةرطةريية سةركةوتووةو ئابورييانة‬
‫كةمتري تيَدةضي َت لةنةشتةرطةري تقليدي وة نةخوَ ش زوَ ر لي ثةسةندة وة‬
‫بةبوَضووني ئيَمة ئةم شيَوازة بةكاربهيَنريَت بوَ هةوكردني َريخوَلَةكويَرةي نا ئالَوَز‪.‬‬

‫‪7‬‬
 ‫( ‪(KAJ)Kurdistan Academician Journal , Sept 2003 , 2(1) Part A, (1-8) 8 -1‬‬ ‫)‬ ‫‪A‬‬
‫‪2003‬‬

‫رفع الزائدة الدودية كجراحة يومية –عملية سليمة واقتصادية‬

‫ف اروق حس ن ف رج‬

‫كلية الطب ‪ /‬جامعة السليمانية ‪ /‬اقليم كوردستان ‪-‬العراق‬

‫ان اهداف هذه الدراسة هي لبيان امكانية اجراء عملية رفع الزائدة الدودية‬
‫كجراحة يومية ومدى ارتياح المرضى لها والفوائد القتصادية من هذه عملية ‪,‬‬
‫اجرى هذا البحث في قسم الطوارىء للمستشفي التعليمي في السليمانية خلل‬
‫فترة حزيران ‪ 1999‬لغاية ايلول ‪ 2000‬وشمل ‪ 170‬مريضا ادخلوا المستشفي‬
‫كحالت التهاب الزائدة الدودية ‪.‬وتم اجراء عملية رفع الزائدة الدودية بطريقة‬
‫مفتوحة واختير ‪ 120‬حالة من حالت التهاب الزائدة الدودية في هذه الدراسة‪ .‬تمت‬
‫تقسيم المرضى الى مجموعتين ‪ ,‬كل مجموعة شملت ‪ 60‬مريضا وان المجموعة‬
‫الولى عولجوا كجراحة يومية بينما المجموعة الثانية كحالت اعتيادية تقليدية وابقوا‬
‫في المستشفي لمدة يوم اواكثر‪ .‬وان المجموعتين كانتا متشابهتين من حيث‬
‫العمار والجنس والوزن ودرجة حرارة الجسم وعدد الكريات الدم البيضاء ‪ ,‬ان‬
‫اهم المقايس في هذه الدراسة كانت مدة البقاء في المستشفى ‪ ,‬رضاء المرضى‬
‫ومضاعفات العملية وكلفة ومصاريف العملية ‪ .‬كانت العمار تتراوح بين ‪ 50-5‬سنة‬
‫ومعدل العمر كان ‪ 22‬سنة ونسبة الدكور الى الناث ‪ 1: 1,14‬ومعدل مدة البقاء في‬
‫المستشفى كانت اقصر في المجموعة الولى ‪7 (,‬ساعات مقابل ‪ 28,9‬ساعات) ‪,‬‬
‫ولم تكن هنالك اختلف احصائى مهم في نسبة المضاعفات في المجموعتين وان‬
‫نسبة الرتياح وقبول المرضي في المجموعة الولى لهذه الطريقة كانت ‪% 98,3‬‬
‫بينما كانت ‪ % 41,5‬في المجموعة الثانية ولم تكن هناك حالت دخول ثانية بعد‬
‫اخراج الرضى من المستشفى وان معدل المصاريف وكلفة العملية ‪,‬عدى تكاليف‬
‫صالة العمليات‪ ,‬في المجموعة الولى كان ‪ 175‬دينارا مقابل ‪ 725‬دينارا للمجموعة‬
‫الثانية‪ ,‬وتبين في هذه الدراسة ان اجراء عملية رفع الزائدة الدودية كجراحة يومية‬
‫عملية ممكينة ‪ ,‬سليمة وامينة واقتصادية‪ ,‬اقل كلفة من الطريقة التقليدية للدولة‪,‬‬
‫وان نسبة ارتياح المرضى لهذه الطريقة عالية لذا نوصى باجراء رفع الزائدة‬
‫الدودية باسلوب الجراحة اليومية بدل من الطريقة التقليدية لحالت التهاب الزائدة‬
‫الدودية الغير معقدة لسباب انفة ذكرها‪.‬‬

‫‪Received16/8/2001 .‬‬ ‫‪16/9/2002‬‬ ‫‪16/8/2001‬‬

‫‪.Accepted 16/6/2002‬‬

‫‪8‬‬
(KAJ)Kurdistan Academician Journal , Sept 2003 , 2(1) Part A, (1-8) 8 -1 ( ) A
2003