H. L. Geist1, E. J. Hughes1, D. M. Relles2, S. Jones-Sapienza2, M. Browne2 1Lehigh Valley Health Network, General Surgery, Allentown, PA, USA 2Lehigh Valley Health Network, Lehigh Valley Reilly Children’s Hospital, Division Of Pediatric Surgical Specialties, Allentown, PA, USA
Introduction:
Appendectomies remain the most common pediatric abdominal surgery with room for improvement regarding cost effectiveness and quality improvement. Same day discharge (SDD) for uncomplicated appendicitis has been shown to have comparable 30 day complication rates, readmissions and ED visits. Despite this fact, the rate of SDD varies from 27-60%. This study aims to evaluate if the time of day of surgery correlates to and significantly impacts SDD in pediatric uncomplicated appendectomies at a single institution.
Methods:
A retrospective study was conducted utilizing the ACS NSQIP-P database for laparoscopic appendectomies performed for acute uncomplicated disease from 01/2018 to 06/2020, after SDD protocol was initiated. Patients with prolonged stays due to medical reasons and complicated (perforated) appendicitis were excluded. Patient charts were reviewed for 30 day readmission, ED visits, surgical site infections, intra-abdominal abscesses, surgery end time and same day/next day discharge. Three time frames were designated to assist in evaluating time of day and associated discharge and were grouped as first third of the day (0000-0759), second third of the day (0800-1559), and last third of the day (1600-1159). Data was analyzed using chi-square analysis.
Results:
After SDD protocol was initiated, 285 patients underwent laparoscopic appendectomy for uncomplicated appendicitis. A total of 27% of these patients were discharged on the same day of their operation. The majority of SDD patients had their operations in the second third of the day (1.3%, 85.7%, 13 %; respectively, p<0.0001) while the majority of next day discharges were in the last third of the day (6.7, 41.8, 51.4%; respectively, p<0.0001) (Table 1). There was no significant difference in complication rates, readmissions, ED visits, SSI, or abscess between the two groups.
Conclusion:
Same day discharge for pediatric uncomplicated appendectomy patients is becoming the standard of care with no significant variability in postoperative readmission and complication rates. Time of day of surgery that occurs in the last third of the day does appear to play a role in preventing SDD. At a single institution with the infrastructure for same day discharge at all times of day, the institutional culture remains more impactful on SDD than evidence-based protocol.
