E. T. Bernard1, D. L. Davenport1, B. Benton1, A. C. Bernard1 1University Of Kentucky,General Surgery,Lexington, KY, USA
Introduction: Recent evidence suggests laparoscopic appendectomy can be performed on a fast-track, short stay, or even outpatient basis. This outpatient appendectomy protocol has been proven to provide high success rates, low morbidity, and low readmissions rates, in addition to a shorter length of hospital stay. Cost savings from outpatient appendectomy have not been reported in the United States. We hypothesize that outpatient laparoscopic appendectomy is associated with cost savings.
Methods: We performed a retrospective analysis of patients undergoing laparoscopic appendectomy between July 2013 and April 2017 at our academic medical center before and after implementation of an outpatient protocol which began on January 1, 2016. We assessed direct costs (OR costs, ED costs, diagnostics, pharmaceuticals), indirect costs, net revenue, contribution margin, and net profit.
Results: The percent of PACU to home discharges increased from 3.4% during the pre-implementation period to 27.0% in the post-implementation period (Chi-square P < .001). The proportion of inpatient and post-OR observation cases decreased by 12.1% and 5.4% respectively. On average, the PACU to home group had a total hospital cost of $4,734 versus $5,787 in the post-OR observation group, for savings of $1,053 per patient. Before and after implementation of the protocol, the average total observation time (pre and post-OR) decreased by 4 hours in those placed in observation post-OR, by 3 hours in those discharged from PACU and 1 hour in those admitted: across all groups total observation time decreased by 2 hours on average (P<.001).
Conclusion: Outpatient appendectomy is associated with approximately $1,000 cost savings per patient. Implementation of an outpatient appendectomy pathway is likely to effect gradual results, but improved resource utilization should occur immediately with respect to shorter observation hours, even for those who are assigned a bed. Considering previous reports that have established safety of the laparoscopic outpatient appendectomy method, our data strongly support widespread implementation of an outpatient appendectomy protocol.
