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

Vera M Funk1, Mason H Remondelli1, Michael Morell2

  • 1School of Medicine, The Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Surgery, The Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Surgery, The Uniformed Services University of the Health Sciences, Bethesda, Maryland.

The Journal of Surgical Research
|December 30, 2025
PubMed
Summary
This summary is machine-generated.

Outpatient laparoscopic appendectomy (OLA) protocols improved surgical outcomes despite variable antibiotic and imaging compliance. Signage enhanced adherence, showing promise for optimizing patient care in emergency general surgery.

Keywords:
Emergency general surgery (EGS)Outpatient laparoscopic appendectomy (OLA)Process improvement (PI)

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Area of Science:

  • General Surgery
  • Surgical Outcomes
  • Healthcare Improvement

Background:

  • Acute appendicitis is a common surgical emergency with variable treatment protocols.
  • A novel Emergency General Surgery Performance Improvement program was established in 2016.
  • An outpatient laparoscopic appendectomy (OLA) protocol was developed to standardize care.

Purpose of the Study:

  • To evaluate the 5-year outcomes of an established OLA protocol.
  • To assess the impact of the OLA protocol on treatment variability and patient care quality.
  • To identify factors influencing protocol adherence and surgical outcomes.

Main Methods:

  • Retrospective review of 104 patients undergoing OLA between 2017 and 2021.
  • Exclusion of patients <18 years, with advanced appendicitis, immunosuppression, pregnancy, or lack of supervision.
  • Statistical analysis using chi-square, Shapiro-Wilk, Kruskal-Wallis, and Mann-Whitney U tests (P < 0.05).

Main Results:

  • Antibiotic and imaging compliance varied significantly over time (P = 0.014 and P = 0.039).
  • Median time to operating room (OR) remained stable at 7.0 hours (P = 0.29).
  • Signage in 2020 improved antibiotic and imaging compliance but not time to OR.

Conclusions:

  • OLA protocol maintained stable surgical outcomes despite compliance variations.
  • Signage effectively reinforced protocol adherence, emphasizing the need for ongoing education.
  • Low complication rates confirm the safety of laparoscopic appendectomy; future focus on compliance and workflow optimization.