Impact of an outpatient appendectomy protocol on clinical outcomes and cost: a case-control study.
BACKGROUND
Although elective outpatient surgery is commonplace, surgeons remain hesitant to discharge patients the same day after emergent surgery. We created a formal protocol to select patients for early discharge after laparoscopic appendectomy for acute appendicitis, and we assessed its safety and potential cost savings.


METHODS
We matched patients who were discharged early from the recovery room with similar patients from a control group on the basis of age ± 3 years, presence or absence of a comorbidity, laparoscopic procedure, and nonperforated appendicitis; we compared them to assess the impact of early discharge on morbidity, return visits to the emergency room, and total cost incurred by our institution.


RESULTS
During the first year of our protocol, 72 of 161 (45%) patients who presented with acute appendicitis and underwent appendectomy were discharged early, with a median post-operative length of stay of 4.7 hours. When compared with matched controls, patients discharged early had similar complication rates (4.3% early group vs 7.1%, p = 0.72) and number of postoperative visits to the emergency room (11.4% vs 11.4%, p = 0.8), but had a reduced median length of stay (4.7 vs 16.2 hours, p < 0.001) and an average reduction in cost of $323.46 per patient.


CONCLUSIONS
Adoption of a protocol to select patients for early discharge after laparoscopic appendectomy resulted in a 45% reduction in the need for in-hospital beds, with no negative impact on return visits to the emergency room or number of complications. This translates to an approximate savings of $323 per patient when compared with standard care.
Dubois
Luc
L
Department of Surgery, Division of General Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada. ldubois@uwo.ca
Vogt
Kelly N
KN
Davies
Ward
W
Schlachta
Christopher M
CM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics* / Q000379:methods / Q000592:standards*; D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000592:standards; D001062:Appendectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods / Q000592:standards*; D001064:Appendicitis / Q000601:surgery; D002170:Canada; D016022:Case-Control Studies; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D010351:Patient Discharge; D055815:Young Adult