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A prospective treatment protocol for outpatient laparoscopic appendectomy for acute appendicitis.

Abstract：

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.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Cash CL,Frazee RC,Abernathy SW,Childs EW,Davis ML,Hendricks JC,Smith RW

doi

10.1016/j.jamcollsurg.2012.02.024

subject

Has Abstract

pub_date

2012-07-01 00:00:00

pages

101-5; discussion 105-6

issue

1

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(12)00273-6

journal_volume

215

pub_type

杂志文章

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