WTP2.04 Resource Saving Strategies for Emergency Appendicectomies: Evaluating the use of Group and Saves and Intra-Abdominal Drains

Aims Appendicitis is the most common abdominal surgical emergency, with approximately 50,000 cases annually in the UK. No national guidance exists regarding routine group and saves (G&S) for emergency laparoscopic surgery. Intraoperative major vessel injury for appendicectomies is rare (0.07-0.12%). World Society of Emergency Surgery Guidelines (WSES) advise complicated appendectomies require drains after consultant discussion if aged >16. This audit aimed to evaluate G&S and drain insertion for emergency appendicectomies against WSES guidelines. Methods Retrospective data was collected between June 2023 – December 2023, identifying 222 patients and analysed using SPSS. Results 72.5% had G&S costing a total of £9340.48. 0 patients required a blood transfusion. All drain decisions were trainee led. Median age of complicated appendicectomies with drains (56 out of 97 patients) was 45.5 (range 7-83). Median age of complicated perforated appendicectomies with drains (46 out of 62 patients) was 43.6 (range 7-83). Perforated appendicectomies with drains (n=46) were found to be statistically significant (P-value 0.000013). For complicated appendicitis, no statistical difference was found between post-operative complications with or without drains (post-operative pneumonia P-value 0.72, post-operative atelectasis P-value 0.72, post-operative collection P-value 0.72 and wound infection P-value 0.41). Length of stay (LOS) was higher in complicated appendicectomies with drains (median LOS 4 days, P-value 0.43). Conclusions This audit highlighted safe practice with no clinical indication of G&S for emergency appendicectomies, driving a significant clinical impact in changing trust guidelines to improve cost-effectiveness. Judicious assessment and universal consensus is needed on the appropriate use of drains.