S. B. Cairo1, D. H. Rothstein1,2 1Women And Children’s Hospital Of Buffalo,Department Of Pediatric Surgery,Buffalo, NY, USA 2State University Of New York At Buffalo,Department Of Surgery,Buffalo, NY, USA
Introduction:
The purpose of this study was to evaluate the influence of discharge timing (same-day vs other) on 30-day hospital readmissions following laparoscopic cholecystectomy in pediatric patients. We also compared wound complication and readmission rates among patients with different indications for operation.
Methods:
The National Surgical Quality Improvement Program-Pediatric database (2012-2014) was queried for patients who underwent laparoscopic cholecystectomy. Variables examined included age, gender, body-mass index, race/ethnicity, diagnosis (cholecystitis vs other), presence of hematologic disorders or diabetes, pre-operative hospital length of stay, and American Society of Anesthesiology (ASA) Physical Status classification. Same-day discharge was defined as zero days between surgery and discharge and was compared to patients discharged within 2 days. The primary outcome was hospital readmission within 30 days after surgery; secondary outcomes included surgical site infections and other wound complications. Forward stepwise logistical regression was used to determine odds ratios for factors contributing to hospital readmissions and wound complications.
Results:
During the study period, 2,825 patients underwent cholecystectomy (74.6% female; median age 13.8 years). Of these, the post-operative diagnosis was gallstone disease (67.4%), cholecystitis (12.9%) and biliary dyskinesia (19.8%). Same-day discharge occurred in 567 patients (20.2%). Among variables measured, only ASA class 3 (compared to ASA class 1) was associated with increased odds of 30-day hospital readmission (OR 1.70, 95% C.I. 1.03-2.81). Same-day discharge was in fact associated with a decreased risk of readmission (OR 0.49, 95% C.I. 0.25-0.96) when compared to discharge within 2 days. A variety of reasons for readmission was identified but did not differ between the same-day and longer discharge groups. When examining wound complications, again only ASA class 3 was associated with increased risk of wound infection or breakdown (OR 4.98, 95% C.I. 1.06-23.4).
Conclusion:
In pediatric patients undergoing laparoscopic cholecystectomy, same-day discharge is associated with no increase in 30-day hospital readmission rates or wound complications when compared to discharge in 1 or 2 days. Specific indications for surgery are also not associated with increased readmission rates or wound complications. Same-day discharge appears safe and therefore may reduce hospital costs and other resource utilization, and serve as an applicable quality indicator for pediatric patients undergoing laparoscopic cholecystectomy.