University of Texas at Southwestern, Dallas, TX, United States.
University of Texas at Southwestern, Dallas, TX, United States; Children's Health, Dallas, TX, United States.
J Pediatr Surg. 2018 May;53(5):988-990. doi: 10.1016/j.jpedsurg.2018.02.031. Epub 2018 Feb 9.
Appendicitis is the most common gastrointestinal pediatric surgical emergency. With the introduction of laparoscopic techniques in the 1990s, recovery, pain, and hospital stay after laparoscopic procedures have been significantly reduced. While many laparoscopic procedures are performed as outpatient surgeries, pediatric appendectomy patients continue to be hospitalized for postoperative observation. Our goal was to evaluate the safety and feasibility of same day discharge after laparoscopic appendectomy for uncomplicated appendicitis.
After IRB approval, all pediatric patients undergoing laparoscopic appendectomy during 2016 for noncomplicated appendicitis were eligible for the study. Decision for same day discharge was based on surgeon preference and parental agreement. Data regarding demographics, admission and discharge times, outcomes of complications, readmissions, return to the ED, and nonscheduled clinic visits were collected.
A total of 1321 appendectomies were performed during the study period, of which 849 were uncomplicated and 382 were discharged same day. There were 2 readmissions, 4 superficial surgical site infections, 10 patients with nausea or vomiting, and 33 patients with pain control issues, 9 of whom presented to the ED.
Same day discharge for laparoscopic noncomplicated appendectomy is a safe and feasible alternative to postoperative admission and observation. This has the potential to yield significant healthcare cost savings.
Level II, Prospective Cohort Study.
阑尾炎是最常见的小儿胃肠道外科急症。自 20 世纪 90 年代引入腹腔镜技术以来，腹腔镜手术的恢复时间、疼痛程度和住院时间均显著缩短。虽然许多腹腔镜手术都作为门诊手术进行，但小儿阑尾切除术患者仍需住院接受术后观察。我们的目标是评估单纯性阑尾炎行腹腔镜阑尾切除术后当日出院的安全性和可行性。
在获得机构审查委员会批准后，所有在 2016 年因非复杂性阑尾炎接受腹腔镜阑尾切除术的小儿患者均有资格参加本研究。是否当日出院的决定基于外科医生的偏好和家长的意见。收集的数据包括人口统计学特征、入院和出院时间、并发症、再入院、返回急诊部、非计划门诊就诊的结果。
在研究期间共进行了 1321 例阑尾切除术，其中 849 例为单纯性阑尾炎，382 例当日出院。有 2 例再入院，4 例浅表手术部位感染，10 例恶心或呕吐，33 例疼痛控制问题，其中 9 例到急诊就诊。
对于腹腔镜单纯性阑尾切除术，当日出院是一种安全且可行的替代术后住院和观察的方法。这有可能带来显著的医疗保健成本节约。
II 级，前瞻性队列研究。
