A Prospective Treatment Protocol for Outpatient Laparoscopic Appendectomy for Acute Appendicitis

• Published in: Journal of the American College of Surgeons Vol. 215; no. 1; pp. 101 - 105
• Main Authors: Cash, Casandra L., MD, Frazee, Richard C., MD, FACS, Abernathy, Stephen W., MD, FACS, Childs, Edward W., MD, Davis, Matthew L., MD, FACS, Hendricks, John C., MD, FACS, Smith, Randall W., MD, FACS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2012; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Appendectomy - methods; Appendicitis - surgery; Biological and medical sciences; Child; Clinical Protocols; Digestive system. Abdomen; Endoscopy; Female; General aspects; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Male; Medical sciences; Middle Aged; Prospective Studies; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Young Adult; NSQIP; National Surgical Quality Improvement Program; PACE; Postanesthesia unit; Human; Appendectomy; Appendicitis; Acute; Patient; Laparoscopy; Medicine; Prospective; Treatment; Vermiform appendix; Surgery; Digestive diseases; Intestinal disease; Endoscopy; Ambulatory
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2012.02.024

Background Many laparoscopic procedures are currently performed on an outpatient basis. Laparoscopic appendectomy, however, continues to require postoperative hospitalization at most institutions. A treatment protocol for outpatient laparoscopic appendectomy was developed to determine if this could be successfully performed without increasing postoperative complications. We hypothesized that adopting an outpatient protocol for laparoscopic appendectomy will significantly increase the rate of outpatient management for uncomplicated appendicitis, without an increase in morbidity or mortality. Study Design We initiated a prospective outpatient protocol for laparoscopic appendectomy in July 2010 at our institution. All patients having laparoscopic appendectomy from July 2010 to March 2011 were included as protocol patients and were retrospectively reviewed. A separate group of patients having laparoscopic appendectomy from January to September 2009 were analyzed as historical controls. These 2 groups were compared for demographics, preoperative comorbidities, outpatient management, and postoperative morbidity by chi-square analysis, with a 0.95 confidence level for statistical significance. Results A total of 116 protocol patients were compared with 119 historical control patients. There were no significant differences in patient demographics, preoperative comorbidities, and pathologic findings between protocol patients and historical controls. Ninety-nine protocol patients (85.3%) had procedures as outpatients compared with 42 historical control patients (35.3%; p < 0.05). Postoperative morbidity occurred in 6 protocol patients (5.2%) and 10 historical controls (8.4%; p = NS). There were no readmissions or mortalities in the protocol group. Conclusions An outpatient protocol for laparoscopic appendectomy significantly increased the rate of outpatient management with no increase in morbidity or mortality. This practice has now become standard of care at our institution.