Outcomes of a Low-cost, Outpatient Laparoscopic Appendectomy Protocol Performed by First-and Second-year General Surgery Residents in Cases of Uncomplicated Appendicitis

Introduction: Appendicitis is one of the most frequent surgical diseases. In uncomplicated appendicitis, outpatient protocols have been shown to significantly reduce costs and can be replicated by residents. In Colombia, this type of protocol has never been evaluated. The aim of this study was to evaluate the outcomes of a low-cost, outpatient laparoscopic appendectomy protocol performed by first-and second-year general surgery residents in uncomplicated appendicitis. Materials and methods: A prospective longitudinal study of outpatient management after laparoscopic appendectomy was conducted in Bogotá, Colombia. It included patients with uncomplicated acute appendicitis and excluded those with evidence of perforation, abscess, or gangrenous appendicitis. The frequency of complications, readmissions, and postoperative pain were evaluated as outcomes. Results: 285 patients were included, with a median age of 28 years and 52.3% (n = 149) were female. All patients had modulated pain and tolerance of the oral route during the postoperative period. There were only 10 (3.5%) readmissions and 12 (4.2%) complications, of which 80% (n = 8) and 58.3% (n = 7) corresponded to the laparoscopic group. On bivariate analysis, no association was found between the frequency of complications and the surgical approach (open vs laparoscopic surgery, p = 0.10), the stage of appendicitis (edematous vs fibrinopurulent, p = 0.14), or the American Society of Anesthesiologists classification (I vs II, p = 0.44). Conclusions: This study demonstrated that the low-cost outpatient management protocol for uncomplicated appendicitis by laparoscopic appendectomy performed by first-and second-year residents had a low frequency of complications and readmission, with no significant differences compared with open surgery or appendicular phase. Clinical significance: The findings of this study have important implications for clinical practice. Outpatient postoperative management can reduce healthcare costs and improve patient satisfaction by reducing hospital stays and facilitating earlier recovery. This alternative should be considered for selected patients who meet the criteria for safe and effective care.