Routine Same-Day Discharge After Acute or Interval Appendectomy in Children: A Prospective Study

• Published in: Archives of surgery (Chicago. 1960) Vol. 147; no. 5; pp. 443 - 446
• Main Authors: Alkhoury, Fuad, Malvezzi, Leopoldo, Knight, Colin G, Diana, Jeannette, Pasaron, Raquel, Mora, JoAnne, Aserlind, Alexandra, Stylianos, Steven, Burnweit, Cathy
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.05.2012
• Subjects: Adolescent; Ambulatory Surgical Procedures; Appendectomy - methods; Biological and medical sciences; Child; Child, Preschool; Children & youth; Cohort Studies; Female; General aspects; Humans; Male; Medical sciences; Parents & parenting; Patient admissions; Patient Discharge; Patient satisfaction; Prospective Studies; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Young Adult; Human; Medicine; Prospective; Appendectomy; Treatment; Vermiform appendix; Acute; Surgery; Routine analysis; Child; Discharge; Interval
• ISSN: 0004-0010; 2168-6254; 1538-3644; 2168-6262
• DOI: 10.1001/archsurg.2012.132

HYPOTHESIS The outcomes of and parental satisfaction with same-day discharge in children undergoing laparoscopic appendectomy warrant making it the usual and customary pathway. DESIGN Prospective cohort study. SETTING Tertiary care children's hospital. PATIENTS Between July 1, 2010, and March 30, 2011, a total of 207 children were considered for same-day discharge after acute or interval laparoscopic appendectomy. The all-in-one single-incision single-instrument technique was used in 95.7% of children. INTERVENTIONS Same-day discharge vs overnight admission. MAIN OUTCOME MEASURES Operative details, postoperative length of stay, adverse events, and parental satisfaction. RESULTS Of 207 consecutive children undergoing acute (n = 186) or interval (n = 21) appendectomy, 162 (78.3%) were discharged on the day of surgery. The remaining 45 children were admitted overnight because the hour was too late for discharge in 35 (77.8%), medical indications dictated admission in 5 (11.1%), and social reasons required admission in 5 (11.1%). In all the children, oral medication alone was used for postoperative pain. The complication rates were similar in the same-day discharge group (8.0%) and in the admitted group (6.6%), as were the rates of urgent postoperative visits (7.4% vs 4.4%%) and the readmission rates (2.5% vs 2.2%) (P > .05 for all). The same-day discharge group had a reduced postoperative length of stay compared with the admitted group (mean, 5 vs 16 hours, P < .05). At the time of discharge, most parents (87.0%) stated they were happy with the expeditious discharge, whereas 8.0% indicated they felt nervous but were ultimately satisfied. In retrospect, 8 of 162 parents (4.9%) were not sure early discharge was best, but only 1 parent would insist on admission if faced with the situation again. CONCLUSION Routine same-day discharge after pediatric appendectomy seems safe, with good parental satisfaction.