title: Outpatient Laparoscopic Appendectomy: Is It Time to End the Discussion?
abstract: BACKGROUND
  Laparoscopic appendectomy is typically associated with inpatient hospitalization averaging between 1 and 2 days. In July 2010, a prospective protocol for outpatient laparoscopic appendectomy was adopted at our institution. Patients were dismissed from the post-anesthesia recovery room or day surgery if they met certain predefined criteria. Patients admitted to a hospital room as either full admission or observation status were considered failures of outpatient management.
  
  
  METHODS
  An IRB-approved, retrospective review of a prospective database was performed on all patients having laparoscopic appendectomy for uncomplicated appendicitis from July 2010 through December 2014. Study exclusions included age younger than 17 years, pregnancy, interval appendectomy, and gangrenous or perforated appendicitis. Patient demographics, success with outpatient management, morbidity, and readmissions were analyzed.
  
  
  RESULTS
  Five hundred and sixty-three patients underwent laparoscopic appendectomy for uncomplicated appendicitis during this time frame. There were 281 men and 282 women, with a mean age of 35.5 years. Four hundred and eighty-four patients (86%) were managed as outpatients. Seventy-nine patients were admitted for pre-existing conditions (32 patients), postoperative morbidity (10 patients), physician discretion (6 patients), or lack of transportation or support at home (31 patients). Thirty-eight patients (6.7%) experienced postoperative morbidity. Seven patients (1.2%) were readmitted after outpatient management for transient fever, nausea/vomiting, migraine headache, urinary tract infection, partial small bowel obstruction, and deep venous thrombosis. There were no mortalities or reoperations. Including the readmissions, overall success with outpatient management was 85%.
  
  
  CONCLUSIONS
  Outpatient laparoscopic appendectomy can be performed with a high rate of success, low morbidity, and low readmission rate. This protocol has withstood the test of time. Widespread adoption has the potential for substantial health care savings.
authors.affiliation: Department of Surgery, Baylor Scott & White Healthcare, Texas A&M Health Science Center, Temple, TX. Electronic address: rfrazee@sw.org.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Frazee
authors.affiliation: Department of Surgery, Baylor Scott & White Healthcare, Texas A&M Health Science Center, Temple, TX.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Abernathy
authors.affiliation: Department of Surgery, Baylor Scott & White Healthcare, Texas A&M Health Science Center, Temple, TX.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Isbell
authors.affiliation: Department of Surgery, Baylor Scott & White Healthcare, Texas A&M Health Science Center, Temple, TX.
authors.forename: Travis
authors.initials: T
authors.lastname: Isbell
authors.affiliation: Department of Surgery, Baylor Scott & White Healthcare, Texas A&M Health Science Center, Temple, TX.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Regner
authors.affiliation: Department of Surgery, Baylor Scott & White Healthcare, Texas A&M Health Science Center, Temple, TX.
authors.forename: Randall D
authors.initials: RD
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult