Division of General,Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Pediatr Surg Int. 2021 Jul;37(7):859-863. doi: 10.1007/s00383-021-04880-8. Epub 2021 Mar 10.
To compare the outcomes and hospital charges of patients who underwent laparoscopic appendectomy for non-perforated appendicitis and were discharged home either shortly after the operation after being admitted for overnight observation.
Postoperative (30-day) emergency department (ED) visits, hospital readmissions, and reoperations were compared between patients who were discharged shortly after surgery (same-day discharge [SDD] group) and patients who were discharged after spending one night in the hospital (overnight observation group).
July/2015 to June/2019. Patients with perforated appendicitis and/or who spent > 1 night in the hospital were excluded from the study.
We did 1957 laparoscopic appendectomies within the 4-year study period. After excluding all non-eligible cases, 930 patients were included in the overnight observation group, and 511 in the SDD group. Mean age and mean operative time were similar in both groups: 11.5 (SD 3.6)/11.8 (SD 3.5) years, and 35 (SD 13)/33 (SD 12) minutes, respectively. There were 24 (2.6%) ED visits within the overnight observation group. Sixteen patients (1.7%) were discharged from the ED, and 8 (0.9%) required a re-admission. There were 11 (2.1%; P = 0.61) ED visits within the SDD group. Six patients (1.1%; P = 0.41) were discharged from the ED, and 5 (1%; P = 0.82) required a readmission. Six of the 11 ED visits within the SDD group occurred on the 5th postoperative day or later, whereas five (1%) occurred within the first 3 days post appendectomy. These five patients would have likely benefited from an overnight admission and were erroneously discharged on the same day of the appendectomy. There were no reoperations in the overnight observation group, but there were 3 reoperations in the SDD group (0.6%, P = 0.01). The reasons for the reoperations (two bowel obstructions and one bowel perforation) were in no way related to the time of the original discharge. The mean hospital charges per patient in the SDD group and the overnight observation group were significantly different: $32,450 and $35,420, respectively (> 9% margin, P < 0.01).
Healthy children who undergo laparoscopic appendectomy for non-perforated appendicitis can be discharged home during the same day of the operation after a short period of observation. This approach is safe and does not result in more postoperative ED visits or hospital readmissions. In addition, there is a significant financial benefit when patients are discharged early.
LEVEL-OF-EVIDENCE: Level III-retrospective comparative treatment study.
比较行腹腔镜阑尾切除术治疗非穿孔性阑尾炎的患者的结局和住院费用，这些患者在接受手术治疗后，分别在术后住院观察过夜后出院，或术后当天出院。
比较术后（30 天）急诊科（ED）就诊、住院再入院和再次手术的患者，这些患者是在术后当天出院（SDD 组）和住院观察过夜（过夜观察组）的患者。
2015 年 7 月至 2019 年 6 月。排除穿孔性阑尾炎和/或住院时间超过 1 晚的患者。
在 4 年的研究期间，我们进行了 1957 例腹腔镜阑尾切除术。排除所有不符合条件的病例后，过夜观察组有 930 例患者，SDD 组有 511 例患者。两组的平均年龄和平均手术时间相似：11.5（SD 3.6）/11.8（SD 3.5）岁和 35（SD 13）/33（SD 12）分钟。过夜观察组有 24 例（2.6%）ED 就诊。16 例患者（1.7%）从 ED 出院，8 例（0.9%）需要再次入院。SDD 组有 11 例（2.1%；P=0.61）ED 就诊。6 例患者（1.1%；P=0.41）从 ED 出院，5 例（1%；P=0.82）需要再次入院。SDD 组的 11 例 ED 就诊中有 6 例发生在术后第 5 天或之后，而有 5 例（1%）发生在阑尾切除术后的前 3 天内。这 5 例患者可能需要住院过夜观察，而错误地在同一天出院。过夜观察组无再次手术，而 SDD 组有 3 例再次手术（0.6%，P=0.01）。再次手术的原因（2 例肠梗阻和 1 例肠穿孔）与最初出院时间无关。SDD 组和过夜观察组每位患者的平均住院费用差异显著：32450 美元和 35420 美元（超过 9%的差异，P<0.01）。
对于非穿孔性阑尾炎行腹腔镜阑尾切除术的健康儿童，可以在术后观察一段时间后当天出院。这种方法是安全的，不会导致术后更多的 ED 就诊或再次住院。此外，当患者提前出院时，会带来显著的经济效益。
III 级-回顾性比较治疗研究。
