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Implementing an outpatient laparoscopic appendectomy (OLA) protocol significantly reduced hospital length of stay (LOS) without increasing complications. This initiative streamlines patient care in military hospitals.

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Area of Science:

  • Surgical outcomes
  • Healthcare management
  • Process improvement

Background:

  • Hospital-specific protocols are crucial for improving patient care and addressing disparities.
  • An outpatient laparoscopic appendectomy (OLA) protocol was evaluated at a tertiary military hospital.
  • The study hypothesized that OLA would decrease length of stay (LOS) without elevating complication rates.

Purpose of the Study:

  • To assess the impact of an OLA protocol on patient LOS.
  • To evaluate complication rates associated with OLA.
  • To determine the feasibility of OLA in a military healthcare setting.

Main Methods:

  • An OLA protocol was implemented in August 2016, defining discharge within 24 hours.
  • Exclusion criteria included pediatric patients, severe appendicitis, immunosuppression, pregnancy, and lack of post-discharge supervision.
  • Analysis of variance compared LOS between 2014 and 2017, with pre- and post-protocol data on successful OLA and readmissions.

Main Results:

  • In 2017, 75% of patients met OLA criteria, with 95% discharged within 24 hours.
  • Complications remained low (one per year) across the study period.
  • Protocol implementation led to a significant reduction in LOS.

Conclusions:

  • The OLA protocol effectively decreased LOS in a military hospital setting.
  • Expansion of the OLA protocol to other Department of Defense (DoD) facilities is recommended.
  • Further research is needed to ascertain the cost benefits for the military health system.