Same-Day Discharge in Laparoscopic Acute Non-Perforated Appendectomy

• Published in: Journal of the American College of Surgeons Vol. 224; no. 1; pp. 43 - 48
• Main Authors: Scott, Andrew, MD, Shekherdimian, Shant, MD, MPH, FACS, Rouch, Joshua D., MD, Sacks, Greg D., MD, PhD, Dawes, Aaron J., MD, PhD, Lui, Wendy Y., MD, FACS, Bridges, Letitia, MD, FACS, Heisler, Tracy, MD, FACS, Crain, Steven R., MD, FACS, Cheung, Mang-King W., PhD, Aboulian, Armen, MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Appendectomy - methods; Appendicitis - surgery; Female; Follow-Up Studies; Humans; Laparoscopy; Male; Middle Aged; Patient Discharge; Retrospective Studies; Surgery; Treatment Outcome
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2016.10.026

Background Small studies done during the past decade have demonstrated same-day discharge after appendectomy as an option for non-perforated appendicitis. Here we have examined a large cohort to confirm that same-day discharge in acute non-perforated appendicitis is a safe option. Study Design This was a retrospective study of patients from 14 Southern California Region Kaiser Permanente medical centers. All patients older than 18 years of age with acute, non-perforated appendicitis who underwent a laparoscopic appendectomy between 2010 and 2014 were included. We compared patients discharged on the day of surgery with patients hospitalized for 1 night. We examined readmission rates, complication rates, postoperative emergency department visits, postoperative diagnostic or therapeutic radiology visits, reoperations, and cost of treatment. Results The cohort was composed of 12,703 patients; 6,710 patients were in the same-day discharge group and 5,993 patients were in the hospitalized group. Patients in the same-day discharge group had a lower rate of readmission within 30 days when compared with the hospitalized group (2.2% vs 3.1%; p < 0.005). In both groups, postoperative rates of visits to emergency or radiology department for diagnostic or therapeutic imaging studies were statistically similar. Postoperative general surgery department visits were slightly higher in the hospitalized group (85% vs 81%; p < 0.001). Conclusions Adult patients with acute, non-perforated appendicitis can be discharged safely on the day of surgery without higher rates of postoperative complication or readmission rates compared with those hospitalized after surgery. In addition, same-day discharge in this patient group is cost-effective.