Same-Day Discharge after pediatric laparoscopic appendectomy for non-perforated acute appendicitis on the rise: Study
USA: A recent study using data from the National Surgical Quality Improvement Program Pediatric (NSQIP-P) database has highlighted a significant increase in same-day discharge (SDD) rate following pediatric laparoscopic appendectomy for non-perforated acute appendicitis. The findings suggest that same-day discharge is becoming more common in pediatric surgical practice, and importantly, it does not come at the cost of increased adverse outcomes or readmissions.
"SDD rates are 20–30% lower than those reported in earlier single-center studies, suggesting that a larger proportion of patients may be eligible for same-day discharge than previously anticipated," the researchers reported in Pediatric Surgery International.
Laparoscopic appendectomy has long been the gold standard for treating appendicitis in children due to its minimally invasive nature and faster recovery time compared to traditional open surgery. However, allowing patients to go home on the same day of surgery, rather than staying overnight for observation, has been more gradual.
Since the practice patterns surrounding same-day discharge for pediatric laparoscopic appendectomy in cases of non-perforated appendicitis have not been thoroughly studied, P. Benson Ham III, University at Buffalo Division of Pediatric Surgery, Jacobs School of Medicine and Biomedical Sciences, NY, USA, and colleagues aimed to evaluate the current practices for same-day discharge in these patients. Additionally, they seek to assess the associated outcomes of this approach.
For this purpose, the researchers utilized the NSQIP-P retrospective registry to identify patients who underwent laparoscopic appendectomy for non-perforated appendicitis between 2017 and 2021. The annual rate of same-day discharge was calculated, and SDD patients were compared to those discharged on postoperative days 1–2 (non-SDD). A subgroup analysis was conducted using ICD-10 code K35.30, and regression analysis was performed to assess the outcomes.
The study led to the following findings:
- Total Patients Identified: 67,214 patients were included in the analysis.
- Same-Day Discharge (SDD) Rate: The SDD rate increased significantly from 33.3% in 2017 to 52.5% in 2021.
- 30-Day Readmission Rates: SDD patients had lower 30-day readmission rates than non-SDD patients (1.3% versus 2.1%).
- Sub-group Analysis: Among 7,330 patients, SDD rates increased from 50.7% in 2019 to 60.4% in 2021, with readmission rates again lower for SDD patients (1.3% versus 2.1%).
- Adverse Events: No increase in adverse events was observed for SDD patients in either analysis.
- Regression Analysis: Patients with esophageal, gastric, or intestinal diseases had significantly higher odds of early readmission or reoperation (OR 1.85).
"Pediatric laparoscopic appendectomy for non-perforated acute appendicitis continues to evolve, with same-day discharge becoming more widespread. With careful patient selection, the trend of early discharge shows promising outcomes, offering a more efficient and patient-centered approach to appendicitis treatment in children," the researchers concluded.
Reference:
Woodward, J.M., Brierley, S.F., Bittner, K. et al. Trends and outcomes in pediatric laparoscopic appendectomy: a NSQIP-P analysis of same-day discharge and readmission rates. Pediatr Surg Int 40, 287 (2024).
https://doi.org/10.1007/s00383-024-05869-9
