Successful implementation of an appendectomy process improvement protocol

Matthew Bradley, Angela Kindvall, Judy Logan, Jeffrey Bailey, Eric Elster, Carlos Rodriguez

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background A key component of a process improvement program is the institution of hospital-specific protocols to address certain disparities and streamline patient care. In that regard, we evaluated the implementation of an outpatient laparoscopic appendectomy (OLA) protocol at a tertiary military hospital. We hypothesized that OLA would reduce length of stay (LOS) without increasing complications. Methods In August 2016, our institution implemented an OLA protocol - defined as discharge within 24 hours of surgery. Exclusion criteria included age <18 years old, grade 4 or 5 appendicitis, immunosuppression, current pregnancy, and no supervision during the first 24 hours postdischarge. To determine OLA's effect on LOS, analysis of variance was used to perform a comparison between the years 2014 and 2017. Successful outpatient appendectomies were recorded preprotocol and postprotocol, as well as readmission complications. Results In 2017, the first full year of protocol implementation, 44 of 59 (75%) patients met the inclusion criteria, and all but 2 (42 of 44, 95%) stayed for less than 24 hours. Of the two outliers, one developed acute on chronic kidney disease and one had a slow return of bowel function following grade 3 appendicitis. Complications were low across all years (one per year). In 2017, the readmission was for percutaneous drainage of an abscess. Overall, protocol implementation produced a significant decrease in LOS. Discussion OLA protocol decreased LOS at a military hospital and should be expanded to other department of defense (DoD) facilities. Further research is needed to identify cost benefit to the military health system. Level of evidence III.

Original languageEnglish
Article numbere000303
JournalTrauma Surgery and Acute Care Open
Issue number1
StatePublished - Jun 1 2019


  • acute appendicitis
  • appendectomy
  • emergency care
  • improve patient care


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