L. O. Benedict1, J. Sujka1, J. Sobrino1, P. Aguayo1, S. St. Peter1, T. Oyetunji1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Department Of Surgery,Kansas City, MO, USA
Introduction: The evolving demands of our current health care system for enhanced efficiency and safety while decreasing hospital length of stay has led to our institutional protocol for same day discharge (SDD) after laparoscopic appendectomy. We have previously demonstrated a 28% rate of same day discharge in children with non-perforated appendicitis. The purpose of our study is to assess effectiveness of a mature protocol for SDD by evaluating discharge success, duration of hospital stay and readmissions.
Methods: A retrospective review of prospectively collected data was conducted. All children undergoing a laparoscopic appendectomy at our freestanding Children's Hospital between December 2015 and July 2017 were included. Patients with non-perforated appendicitis were classified according to whether they were discharged home the same day as their operation or had an overnight stay. Demographic data, time of day the procedure was completed, post-operative length of stay and readmission rates were abstracted from patient medical records. Comparative analysis was performed in STATA using chi square or fisher exact test for categorical variables and t-test for continuous variables.
Results: A total of 569 children were included, with 87% (n=495) discharged home the same day as their appendectomy. Of the patients discharged home the same day of surgery, their median length of post-operative stay was 4 hours (IQR: 3, 5) compared to 19 hours for the patients who stayed overnight (IQR: 15,25, p<.0001). Approximately two-thirds of patients who had their appendectomies after 6pm stayed overnight. In addition, patients discharged home the same day had significantly lower readmission rates than patients who stayed overnight (1% vs. 4%, p=.038).
Conclusion: After laparoscopic appendectomy in children with non-perforated appendicitis, SDD not only reduces post-operative length of stay but is not associated with higher readmission rates.