Trends and outcomes in pediatric laparoscopic appendectomy: a NSQIP‑P analysis of same‑day discharge and readmission rates
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John M. Woodward, Stephanie F. Brierley, Krystle Bittner, Katherine Foote, Hector Osei, Carroll M. Harmon & P. Benson Ham III
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
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Can pediatric patients who had a laparoscopic appendectomy be discharged home on the same day, and how does same-day discharge affect their outcomes? I'm Lizzie Lee from Cincinnati Children's Hospital, and this is an article you should know about. This study used data from the NQUIP registry from 2017 to 2021 to look at same-day discharge for patients with non-perforated appendicitis who underwent laparoscopic appendectomy. The same-day discharge rate increased from 33% in 2017 to 52% in 2021. Those discharged on the same day had fewer 30-day readmissions and lower rates of superficial surgical site infections compared to those discharged on post-op day one or two. There was no increase in adverse events for patients with same-day discharge, suggesting that same-day discharge is becoming more common and does not negatively impact outcomes. Let us know what you think in the comments below, and stay tuned for more articles that you should know about.