Expedited discharge in uncomplicated acute appendicitis: Decreasing the length of stay while maintaining quality

An expedited discharge protocol for uncomplicated appendicitis was developed at a Canadian academic hospital to determine if patients could be safely discharged home early without negatively impacting care and patient satisfaction.

A non-randomized prospective quality improvement project was completed between February 01, 2017 and January 31, 2018. The project included patients between 16 and 65 years with uncomplicated appendicitis managed with laparoscopic appendectomy. The primary outcome was average length of stay post PACU. 30 day ED visit, cross-sectional imaging and readmission rate were balancing measures. The CTM-3 tool was used to measure patient satisfaction.

450 patients had emergent laparoscopic appendectomy. 287 (63.8%) patients met the project inclusion criteria. The average length of stay decreased 41.0% to 13.1 h. The 30 day ED visit, cross-sectional imaging and readmission rate were 9.8%, 4.5% and 1.0% respectively compared with 8.1%, 4.5% and 2.5% at baseline. Patient satisfaction was 3.72/4 compared to 3.74/4.

An expedited discharge after an uncomplicated laparoscopic appendectomy is safe and feasible without a negative impact on 30-day ED visit, diagnostic imaging or readmission.