Same-day discharge appendicectomy protocol (SDAP): implementation and outcomes from an Australian prospective study

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Acute appendicitis is one of the three most common causes for emergency admission for which many patients with uncomplicated appendicectomies require minimal post-operative care. International studies have demonstrated same-day discharge appendicectomy protocols as a safe management option without increased rates of re-admission, re-presentations or complications, and lower hospital length of stay (LOS). Despite this, there is limited contemporary Australian adult data incorporating such protocols. The objective of this study is to evaluate the safety, feasibility, outcomes and healthcare costs of a structured same-day discharge appendicectomy protocol (SDAP) for uncomplicated laparoscopic appendicectomies at an Australian tertiary centre. A Same-Day Discharge Appendicectomy Protocol (SDAP) was implemented at an Australian adult tertiary hospital with prospective data collected over 12-months (Apr 2023–Apr 2024) and compared to a historical cohort of appendicectomy cases from the preceding year (2022). All patients presenting with clinical or imaging diagnosed appendicitis booked for an emergency laparoscopic appendicectomy were automatically entered into the SDAP pathway, with predefined pre-operative and intra-operative exclusion criteria to identify patients eligible for same-day discharge (SDD). SDD was defined as discharged on the same calendar day as the operation. Primary outcomes were hospital LOS (days) and admission cost (AUD). Secondary outcomes included 30-day re-admission, re-presentation, post-operative complications, SDD rate and barriers to SDD. During implementation, 280 patients underwent laparoscopic appendicectomy of whom 156 (56%) were SDD-eligible. In comparison to the historical control group, 257 patients underwent laparoscopic appendicectomy with 154 (60%) retrospectively meeting SDD-eligibility. SDD increased significantly after SDAP implementation, from 13 (8%) to 60 (38%) ( p < 0.001). Median hospital LOS was reduced amongst SDAP-SDD compared to pre-SDAP SDD-eligible cohort (1.2 vs 2.0 days, p < 0.0001). Median admission cost was lower for SDAP-SDD patients than for the pre-SDAP SDD-eligible cohort ($5112.34 vs $7841.14, p < 0.0001). There was no observed difference in 30-day re-admission (0.0% vs 1.9% p = 0.561), re-presentation (1.7% vs 4.5%; p = 0.447) and post-operative complication (1.7% vs 1.9% p = 1.000) between SDAP-SDD and pre-SDAP SDD-eligible cohort. Implementation of SDAP was associated with significant reduction in hospital LOS and lower inpatient admission costs with no observed difference in post-operative outcomes. Wider adoption of similar protocols may improve hospital bed-flow and resource efficiency.

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