Outpatient laparoscopic appendectomy can be successfully performed for uncomplicated appendicitis: A Southwestern Surgical Congress multicenter trial

Published:September 18, 2017DOI:



      Many laparoscopic procedures are now performed on an outpatient basis. We hypothesize laparoscopic appendectomy can be safely performed as an outpatient procedure.


      Seven institutions adopted a previously described outpatient laparoscopic appendectomy protocol for uncomplicated appendicitis. Patients were dismissed unless there was a clinical indication for admission. Patient demographics, success with outpatient management, time of dismissal, morbidity, and readmissions were analyzed.


      Two hundred six men and one hundred seventy women with a mean age of 35.4 years were included in the protocol. Seventy-eight patients (21%) had pre-existing comorbidities. 299 patients (80%) were managed as outpatients. There were no conversions to open appendectomy. Postoperative morbidity was 5%. The time of patient dismissals was evenly distributed throughout the day and night. Twelve patients (3%) required readmission. Outpatient follow-up occurred in 63% of patients.


      An outpatient laparoscopic appendectomy protocol was successfully applied at multiple institutions with low morbidity and low readmission rates. Application of this practice nationally could reduce length of stay and decrease overall health care costs for acute appendicitis.
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        • Frazee R.C.
        • Roberts J.W.
        • Symmonds R.E.
        • et al.
        A prospective randomized trial comparing open versus laparoscopic appendectomy.
        Ann Surg. 1994 Jun; 219: 725-728
        • Paquette I.M.
        • Smink D.
        • Finlayson S.R.
        Outpatient cholecystectomy at hospitals versus freestanding ambulatory surgical centers.
        J Am Coll Surg. 2008 Feb; 206 (Epub 2007 Nov 26): 301-305
        • Kalogera E.
        • Bakkum-Gamez J.N.
        • Jankowski C.J.
        • et al.
        Enhanced recovery in gynecologic surgery.
        Obstet Gynecol. 2013; 122: 319-328
        • Moreno-Egea Alfredo
        • Cartagena Joaquin
        • Vicente Juan Pablo
        • Carrillo Andres
        • Aguayo Jose Luis
        Laparoscopic incisional hernia repair as a day surgery procedure.
        Surg Laparosc Endosc Percutaneous Tech. 2008; 18: 267-271
        • Badaoui R.
        • Alami Chentoufi Y.
        • Hchikat A.
        • et al.
        Outpatient laparoscopic sleeve gastrectomy: first 100 cases.
        J Clin Anesth. 2016; 34: 85-90
        • Worni M.
        • Østbye T.
        • Gandhi M.
        • et al.
        Laparoscopic appendectomy outcomes on the weekend and during the week are no different: a national study of 151,774 patients.
        World J Surg. 2012; 36: 1527-1533
        • Alkhoury F.
        • Burnweit C.
        • Malvezzi L.
        • et al.
        A prospective study of safety and satisfaction with same-day discharge after laparoscopic appendectomy for acute appendicitis.
        J Pediatr Surg. 2012; 47: 313-316
        • Cash C.L.
        • Frazee R.C.
        • Abernathy S.W.
        • et al.
        A prospective treatment protocol for outpatient laparoscopic appendectomy for acute appendicitis.
        J Am Coll Surg. 2012; 215 (discussion 105-6): 101-105
        • Salam I.M.
        • Fallouji M.A.
        • el Ashaal Y.I.
        • et al.
        Early patient discharge following appendicectomy: safety and feasibility.
        J R Coll Surg Edinb. 1995; 40: 300-302
        • Savage S.A.
        • Klekar C.S.
        • Priest E.L.
        • Crandall M.L.
        • Rodriguez B.C.
        • Shafi S.
        • AAST Patient Assessment Committee
        Validating a new grading scale for emergency general surgery diseases.
        J Surg Res. 2015 Jun 15; 196: 264-269
        • Ljungqvist O.
        • Scott M.
        • Fearon K.C.
        Enhanced recovery after surgery: a review.
        JAMA Surg. 2017; 152: 292-298
        • Alawadi Zeinab M.
        • Leal Isabel
        • Phatak Uma R.
        • et al.
        Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: a provider and patient perspective.
        Surgery. 2016; 159: 700-712
        • Forsmo H.M.
        • Pfeffer F.
        • Rasdal A.
        • Sintonen H.
        • Körner H.
        • Erichsen C.
        Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) program reduces length of hospital stay in colorectal surgery.
        Int J Surg. 2016 Dec; 36 (Epub 2016 Oct 22): 121-126
        • Arsalani-Zadeh R.
        • ElFadl D.
        • Yassin N.
        • MacFie J.
        Evidence-based review of enhancing postoperative recovery after breast surgery.
        Br J Surg. 2011; 98: 181-196
        • Aasa A.
        • Hovbäck M.
        • Berterö C.M.
        The importance of preoperative information for patient participation in colorectal surgery care.
        J Clin Nurs. 2013; 22: 1604-1612
        • Lezana Pérez M.Á.
        • Carreño Villarreal G.
        • Lora Cumplido P.
        • Alvarez Obregón R.
        Comparative study of ambulatory laparoscopic cholecystectomy versus management of laparoscopic cholecystectomy with conventional hospital stay.
        Cir Esp. 2013 Aug-Sep; 91 (Epub 2013 Jan 17): 424-431
        • Gonzalez T.
        • Fisk E.
        • Chiodo C.
        • Smith J.
        • Bluman E.
        Economic analysis and patient satisfaction associated with outpatient total ankle arthroplasty.
        Foot Ankle Int. 2017 May; 38: 507-513
        • Anderson K.A.
        • Abernathy S.W.
        • Jupiter D.
        • Frazee R.C.
        Patient satisfaction after outpatient appendectomy.
        J Laparoendosc Adv Surg Tech A. 2016 Dec; 26 (Epub 2016 Jun 10): 954-957
        • Cash C.L.
        • Frazee R.C.
        • Smith R.W.
        • et al.
        Outpatient laparoscopic appendectomy for acute appendicitis.
        Am Surg. 2012; 78: 213-215
        • Scott A.
        • Shekherdimian S.
        • Rouch J.D.
        • et al.
        Same-day discharge in laparoscopic acute non-perforated appendectomy.
        J Am Coll Surg. 2017; 224: 43-48
        • Guller Ulrich
        • Hervey Sheleika
        • Purves Harriett
        • et al.
        Laparoscopic versus open appendectomy-outcomes comparison based on a large administrative database.
        Ann Surg. 2004 Jan; 239: 43-52

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