Trends and outcomes in pediatric laparoscopic appendectomy: a NSQIP-P analysis of same-day discharge and readmission rates
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In brief
In brief
This NSQIP-P registry analysis of 67,214 pediatric patients shows same-day discharge after laparoscopic appendectomy for non-perforated appendicitis increased from 33% to 53% between 2017-2021, with lower readmission rates compared to overnight stays. The findings suggest current practice is conservative and more patients could safely be discharged same-day.
- Same-day discharge after laparoscopic appendectomy for non-perforated appendicitis increased from 33% to 53% (2017-2021) without increased complications.
- Same-day discharge patients had lower 30-day readmission rates compared to those staying 1-2 days (1.3% vs 2.1%, p<0.001).
- Current national same-day discharge rates are 20-30% lower than single-center studies suggest is safe, indicating opportunity for practice change.
- Patients with esophageal/gastric/intestinal comorbidities have 1.85x increased odds of early readmission or reoperation.
- NSQIP-P data supports same-day discharge as safe standard practice for uncomplicated pediatric laparoscopic appendectomy.
Written by the GCMD Library team from the article.
Abstract
Purpose
Practice patterns of same-day discharge for pediatric laparoscopic appendectomy for non-perforated appendicitis are not well-analyzed. Our aim is to evaluate current practice patterns and outcomes of same-day discharge for these patients.
Methods
NSQIP-P retrospective registry identified patients (2017–2021) who underwent laparoscopic appendectomy for non-perforated appendicitis. Annual same-day discharge (SDD) rate was determined. SDD patients were compared to those discharged postoperative days 1–2 (non-SDD). Sub-group analysis was performed on ICD-10 code K35.30. Regression was performed.
Results
Overall, 67,214 patients were identified. The SDD rate increased from 33.3% (2017) to 52.5% (2021) with decreased 30-day readmissions between SDD and non-SDD (1.3% vs 2.1%, p < 0.001). Sub-group analysis identified 7,330 patients with SDD rates from 50.7% (2019) to 60.4% (2021) with decreased 30-day readmissions (1.3% vs 2.1%, p < 0.001) for SDD versus non-SDD. No increase in adverse events for SDD occurred in either analysis. Regression identified esophageal/gastric/intestinal diseases increased odds of early readmission or reoperation (OR 1.85, p = 0.042).
Conclusion
Same-day discharge after pediatric laparoscopic appendectomy for non-perforated acute appendicitis continues to increase in frequency without a significant increase in adverse outcomes. SDD rates are 20–30% lower than previously published single-center studies, indicating there is a likely a larger percentage of patients that could discharge same-day.
Level of evidence (I–V)
Level III.