Department of Pediatric Surgery, The Children's Mercy Hospital, Kansas city, Missouri.
Department of Pediatric Surgery, The Children's Mercy Hospital, Kansas city, Missouri.
J Surg Res. 2014 Jul;190(1):93-7. doi: 10.1016/j.jss.2014.03.012. Epub 2014 Mar 12.
Although many laparoscopic procedures are performed on an outpatient basis, patients who have undergone a laparoscopic appendectomy have typically stayed at least overnight. Recently, data in both the pediatric and adult literature suggest that same day discharge (SDD) for acute nonperforated appendicitis is safe and associated with high patient and parent satisfaction. We have recently begun attempting SDD for nonperforated appendicitis, and this study is an analysis of our initial experience.
A retrospective chart review of all patients who underwent laparoscopic appendectomy for nonperforated appendicitis at our institution from January 2012 to July 2013 was performed. Demographics, length of stay, hospital course, and outcomes were measured. Data are expressed as mean±standard deviation. Comparative analysis was performed using a t-test.
A total of 588 laparoscopic appendectomies for nonperforated appendicitis were performed over an 18-mo period. Approximately 28% (n=128) were discharged on the day of surgery. Of the remaining patients, 12.9% (n=59) stayed overnight for medical reasons, 0.4% (n=2) stayed for social reasons, 3.9% (n=18) stayed because the operation ended late in the evening, and 82.8% (n=381) stayed because of clinical care habits. Compared with patients who stayed overnight, there was no statistically significant difference in readmission rates (0.7% versus 1.9%, P=0.6%), follow-up before scheduled appointment (5.4% versus 5.4%, P=1.0), and complication rate (0.7% versus 2.6%, P=0.3). Patients whose operation ended later in the day had a longer hospital stay. We observed a trend toward more SDDs, the further we got from the initiation of our protocol.
SDD is safe for children undergoing laparoscopic appendectomy for nonperforated appendicitis. The two main barriers to SDD were time of day for the operation and provider habit, both of which improved as more practitioners felt comfortable with the concept. SDD requires extensive education within the hospital system, and we have initiated an aggressive prospective protocol to improve the results.
尽管许多腹腔镜手术都是在门诊进行的，但接受腹腔镜阑尾切除术的患者通常至少要住院一晚。最近，儿科和成人文献中的数据表明，对于急性非穿孔性阑尾炎，当天出院（SDD）是安全的，并且患者和家长满意度高。我们最近开始尝试对非穿孔性阑尾炎进行 SDD，本研究分析了我们的初步经验。
对 2012 年 1 月至 2013 年 7 月在我院接受腹腔镜阑尾切除术治疗非穿孔性阑尾炎的所有患者进行回顾性病历回顾。测量人口统计学、住院时间、住院过程和结果。数据表示为平均值±标准差。使用 t 检验进行比较分析。
在 18 个月的时间内，共进行了 588 例非穿孔性阑尾炎腹腔镜阑尾切除术。大约 28%（n=128）在手术当天出院。在其余患者中，由于医疗原因住院 1 晚的占 12.9%（n=59），因社会原因住院的占 0.4%（n=2），因手术结束较晚而住院的占 3.9%（n=18），因临床护理习惯而住院的占 82.8%（n=381）。与住院一晚的患者相比，再入院率无统计学差异（0.7%对 1.9%，P=0.6%），预约前随访率（5.4%对 5.4%，P=1.0）和并发症发生率（0.7%对 2.6%，P=0.3）。手术结束较晚的患者住院时间较长。我们观察到，随着我们开始实施协议，SDD 的数量呈上升趋势。
对于接受腹腔镜阑尾切除术治疗非穿孔性阑尾炎的儿童，SDD 是安全的。SDD 的两个主要障碍是手术时间和提供者习惯，随着更多的从业者对这一概念感到舒适，这两个障碍都得到了改善。SDD 需要在医院系统内进行广泛的教育，我们已经启动了一项积极的前瞻性方案来改善结果。
