K. Gee1, S. Ngo1, A. Beres1 1University Of Texas Southwestern Medical Center,Department Of Surgery, Division Of Pediatric Surgery,Dallas, TX, USA
Introduction: Appendicitis remains the most common gastrointestinal pediatric surgical emergency. With the introduction of laparoscopic techniques in the 1990s, recovery, pain and hospital stay after laparoscopic procedures have been significantly reduced. Through 2015 our institution routinely admitted uncomplicated appendicitis patients for overnight observation after laparoscopic appendectomy. Given the increasing body of evidence suggesting the safety and feasibility of same day discharge after uncomplicated appendectomies we elected to perform a prospective study evaluating the complication rates of same day discharge appendectomies compared to overnight observation.
Methods: After IRB approval, all pediatric patients who underwent laparoscopic appendectomies for uncomplicated appendicitis in 2016 were observed. Decision for same day discharge was based on surgeon preference and parental agreement. Data regarding demographics, admission and discharge times and outcomes of complications, readmissions, return to the ED and non-scheduled clinic visits were collected and analyzing using chi-square and multivariate regression.
Results: A total of 1321 appendectomies were performed during the study period; 849 were uncomplicated, of which 382 were discharged same day and 467 were admitted for overnight observation. Univariate analysis revealed no statistical difference between readmission rates for same day vs observation (2 vs 6 patients, p=0.21) or in emergency department visits (22 vs 27 patients, p=0.98). There was also no difference between the number of surgical site infections or the number of patients who required an extra clinic visit. On multivariate logistic regression, controlling for age, gender and discharge from PACU vs floor, there was a significant difference only for calls related to pain favoring those who went home same day (OR=0.88, p value 0.008).
Conclusion: Same day discharge for laparoscopic non-complicated appendectomy is a safe and feasible alternative to post-operative admission and observation. In our prospective study of 849 patients there were no differences in outcomes between the two groups. This has the potential to yield significant healthcare cost savings.