INTRODUCTION Eliminating points in the continuum of care that do not change management is a safe strategy for cost containment and workflow efficiency in health systems. As a process improvement initiative, we sought to identify whether routine, outpatient follow-up changes management in laparoscopic appendectomy in a military hospital. METHODS We performed a retrospective chart review of adult patients undergoing laparoscopic appendectomy during a one-year period. The primary outcome was identification of a change in management during routine in person follow-up. Secondary outcomes included location of patient presentation with a post-operative event (clinic, emergency department, primary care provider), and if those visits changed management. Events were defined as any deviation from the typical post-operative course within 6 weeks of surgery, including abnormal specimen pathology. RESULTS One-hundred and seventy-six appendectomies were performed over one year, and 148 patients met inclusion criteria (median age = 27, 66.9% male). Perforation was identified in 10.1% of patients. Seventeen-point-five percent of patients had a post-operative event, of which persistent pain was the most common. Only 2.0% of all patients saw a change in management at their routine in person follow-up appointment. Eighty percent of patients with any post-operative events sought care outside of their routine in person follow up appointments. No variable was independently associated with a change in management. CONCLUSION Routine in-person clinical follow-up for laparoscopic appendectomy almost never changes management. Perforated appendicitis may be an indication for in-person follow-up. Considering a telemedicine model for post-operative follow-up of laparoscopic appendectomy patients will provide a safe and effective alternative to in-person clinic visits, while saving patients time and allowing providers the clinic freedom to prioritize more urgent and new patients.

中文翻译：

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不复杂的腹腔镜阑尾切除术的常规现场术后随访不会改变管理。

引言 消除连续护理中不会改变管理的点是卫生系统成本控制和工作流程效率的安全策略。作为一项流程改进计划，我们试图确定军队医院腹腔镜阑尾切除术的常规门诊随访是否改变了管理。方法 我们对一年内接受腹腔镜阑尾切除术的成年患者进行了回顾性图表审查。主要结果是在常规个人随访期间确定管理的变化。次要结果包括出现术后事件的患者就诊地点（诊所、急诊科、初级保健提供者），以及这些就诊是否改变了管理。事件定义为手术后 6 周内与典型术后病程的任何偏差，包括异常标本病理。结果 一年内进行了 176 例阑尾切除术，148 例患者符合纳入标准（中位年龄 = 27，66.9% 为男性）。10.1% 的患者发现穿孔。百分之十七五的患者有术后事件，其中最常见的是持续性疼痛。只有 2.0% 的患者在他们的常规随访预约中看到了管理上的变化。有任何术后事件的患者中有 80% 会在常规随访预约之外寻求护理。没有变量与管理变化独立相关。结论 腹腔镜阑尾切除术的常规现场临床随访几乎从不改变管理。穿孔性阑尾炎可能是现场随访的指征。