A Follow-up of an Outpatient Laparoscopic Appendectomy Protocol at a Tertiary Care Military Hospital

Acute appendicitis is one of the most common reasons for emergency general surgery, with more than 1 in 20 Americans expected to develop it during their lifetime. Despite its prevalence, there is significant variability in the treatment of acute appendicitis, particularly in the use of antibiotics, imaging modalities, and length of hospital stay. In 2016, our military medical institution established a novel Emergency General Surgery Performance Improvement program. As part of this initiative, we developed disease-specific protocols, including an outpatient laparoscopic appendectomy (OLA) protocol, to reduce treatment variability, improve efficiency, and optimize the quality of patient care. This is a 5-yreview of our appendectomy protocol.

Our institution implemented an OLA, which outlined specific imaging and antibiotic administration, and minimized the hospital length of stay to within 24 h. Data from patients undergoing OLA between 2017 and 2021 were retrospectively reviewed. Exclusion criteria included age < 18 y, advanced appendicitis, immunosuppression, pregnancy, or lack of postdischarge supervision. Categorical variables were compared using chi-square tests. Continuous variables (age, time to operating room [OR]) were tested for normality with the Shapiro-Wilk test and reported as median (Q1, Q3). Nonparametric comparisons across years used the Kruskal-Wallis test; 2020 (signage posted) was compared to other years using the Mann-Whitney U test. Significance was set at P < 0.05.

A total of 104 patients met inclusion criteria (median age 35 y; 60% male). Antibiotic compliance ranged from 56% to 93%, and imaging compliance from 75% to 100%, both varying significantly over time (P = 0.014 and P = 0.039, respectively). Median time to OR remained stable at 7.0 h (interquartile range 6.0-10.0), with no significant yearly difference (P = 0.29). In 2020, signage was associated with higher antibiotic (P = 0.001) and imaging compliance (P = 0.001), but not shorter time to OR (P = 0.35). Complications were rare (2%).

Despite variations in antibiotic and imaging compliance, key surgical outcomes, including time to the OR and hospital length of stay, remained stable. Signage reinforced protocol adherence, highlighting the importance of ongoing education. The low complication rate supports the overall safety of laparoscopic appendectomy. Future efforts should focus on improving compliance and optimizing preoperative workflows to enhance patient care.