Cairo Sarah B, Raval Mehul V, Browne Marybeth, Meyers Holly, Rothstein David H
Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York.
Department of Pediatric Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia.
JAMA Surg. 2017 Dec 1;152(12):1106-1112. doi: 10.1001/jamasurg.2017.2221.
Appendectomy is the most common abdominal operation performed in pediatric patients in the United States. Studies in adults have suggested that same-day discharge (SDD) after appendectomy is safe and does not result in higher-than-expected hospital readmissions.
To evaluate the influence of SDD on 30-day readmission rates following appendectomy for acute appendicitis in pediatric patients.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database to evaluate 30-day readmission rates among pediatric patients who underwent an appendectomy for acute, nonperforated appendicitis. The database provides high-quality surgical outcomes data from more than 80 participating US hospitals, including free-standing pediatric facilities, children's hospitals, specialty centers, children's units within adult hospitals, and general acute care hospitals with a pediatric wing. Patients selected for inclusion (n = 22 771) were between ages 0 and 17 years and underwent appendectomy for uncomplicated appendicitis between January 1, 2012, and December 31, 2015. Patients excluded were those discharged more than 2 days after surgery.
Same-day discharge after appendectomy or discharge 1 or 2 days after surgery.
The primary outcome was 30-day readmission. Secondary outcomes included surgical-site infections and other wound complications.
Of the 20 981 patients, 4662 (22.2%) had SDD and 16 319 (77.8%) were discharged within 1 or 2 days after surgery. The patient cohort included 12 860 boys (61.3%) and 8121 girls (38.7%), with a mean (SD) age of 11.0 (3.56) years. There was no difference in the odds of readmission for patients with SDD compared with those discharged within 2 days (adjusted odds ratio [aOR], 0.82; 95% CI, 0.51-1.04; P = .06; readmission rate, 1.89% vs 2.33%). There was no significant difference in reason for readmission on the basis of discharge timing. Likewise, there was no difference in wound complication rate between patients with SDD and those discharged 1 or 2 days after surgery (aOR 0.75; 95% CI, 0.56-1.01; P = .06).
In pediatric patients with acute appendicitis undergoing appendectomy, SDD is not associated with an increase in 30-day hospital readmission rates or wound complications when compared with discharge 1 or 2 days after surgery. Same-day discharge may be an applicable quality metric for the provision of safe and efficient care for pediatric patients with acute, nonperforated appendicitis.
在美国，阑尾切除术是儿科患者最常见的腹部手术。针对成人的研究表明，阑尾切除术后当日出院（SDD）是安全的，且不会导致高于预期的再次入院率。
评估当日出院对儿科患者急性阑尾炎阑尾切除术后30天再入院率的影响。
设计、设置和参与者：这项回顾性队列研究使用了美国外科医师学会国家外科质量改进计划 - 儿科数据库，以评估因急性、非穿孔性阑尾炎接受阑尾切除术的儿科患者的30天再入院率。该数据库提供了来自美国80多家参与医院的高质量手术结果数据，包括独立的儿科设施、儿童医院、专科中心、成人医院内的儿科病房以及设有儿科科室的综合急性护理医院。纳入的患者（n = 22771）年龄在0至17岁之间，于2012年1月1日至2015年12月31日期间因单纯性阑尾炎接受阑尾切除术。排除的患者为术后超过2天出院者。
阑尾切除术后当日出院或术后1天或2天出院。
主要结局是30天再入院。次要结局包括手术部位感染和其他伤口并发症。
在20981例患者中，4662例（22.2%）当日出院，16319例（77.8%）在术后1天或2天出院。患者队列包括12860名男孩（61.3%）和8121名女孩（38.7%），平均（标准差）年龄为11.0（3.56）岁。与术后2天内出院的患者相比，当日出院患者的再入院几率无差异（调整后的优势比[aOR]，0.82；95%置信区间，0.51 - 1.04；P = 0.06；再入院率，1.89%对2.33%）。基于出院时间的再入院原因无显著差异。同样，当日出院患者与术后1天或2天出院患者的伤口并发症发生率无差异（aOR 0.75；95%置信区间，0.56 - 1.01；P = 0.06）。
对于接受阑尾切除术的儿科急性阑尾炎患者，与术后1天或2天出院相比，当日出院与30天再入院率增加或伤口并发症无关。当日出院可能是为患有急性、非穿孔性阑尾炎的儿科患者提供安全有效护理的适用质量指标。
