Zheng Yifei, Qi Shiqin
Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China.
Front Pediatr. 2022 Jul 4;10:944405. doi: 10.3389/fped.2022.944405. eCollection 2022.
To compare the readmission rate, rate of urgent/unplanned visits to emergency, complication rate along with cost of health care among children and adolescents who were discharged the same day following a laparoscopic appendectomy and those who were not discharged on the same day.
A systematic search was performed in the PubMed, Embase, and Scopus databases. Randomized controlled trials and studies, observational in design, were considered for inclusion. The included studies were conducted in children and adolescents with uncomplicated appendicitis undergoing laparoscopic appendectomy and compared outcomes of interest between patients that were discharged the same day (SDD group) following the operation and patients that were discharged within 2 days post-operatively (non-SSD group). Statistical analysis was performed using STATA software. Effect sizes were reported as pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals.
A total of 13 studies with 32,021 children and adolescents were included. There was no significant difference in the risks of unplanned visit to the emergency department (OR 1.07, 95% CI: 0.78, 1.47), readmission (OR 0.83, 95% CI: 0.66, 1.05), reoperation/re-intervention (OR 1.73, 95% CI: 0.19, 16.2) and complications (OR 0.84, 95% CI: 0.67, 1.06) in both groups of patients. Patients in the SDD group had slightly lower risk of wound infection/complication (OR 0.74, 95% CI: 0.57, 0.96) compared to patients in the non-SDD group. Those with SDD had to incur comparatively lesser hospital expense (in USD) compared to those with no SDD (WMD -2587.4, 95% CI: -4628.3, -546.6).
In children and adolescents with uncomplicated acute appendicitis undergoing laparoscopic appendectomy, same-day discharge is not associated with increased readmission risk, unplanned visits to emergency, and complications. Further, SDD is associated with lower cost of hospital care. Adoption of SDD in this subset of children and adolescents may be encouraged.
[www.crd.york.ac.uk/prospero], identifier [CRD420 22320539].
比较腹腔镜阑尾切除术后当日出院与非当日出院的儿童及青少年的再入院率、急诊紧急/非计划就诊率、并发症发生率以及医疗保健费用。
在PubMed、Embase和Scopus数据库中进行系统检索。纳入随机对照试验和观察性研究。纳入的研究针对患有非复杂性阑尾炎并接受腹腔镜阑尾切除术的儿童及青少年，比较手术当日出院患者（当日出院组）与术后2天内出院患者（非当日出院组）的相关结局。使用STATA软件进行统计分析。效应量以合并比值比（OR）或加权平均差（WMD）及95%置信区间表示。
共纳入13项研究，涉及32,021名儿童及青少年。两组患者在非计划急诊就诊风险（OR 1.07，95% CI：0.78，1.47）、再入院风险（OR 0.83，95% CI：0.66，1.05）、再次手术/再次干预风险（OR 1.73，95% CI：0.19，16.2）和并发症风险（OR 0.84，95% CI：0.67，1.06）方面无显著差异。与非当日出院组患者相比，当日出院组患者伤口感染/并发症风险略低（OR 0.74，95% CI：0.57，0.96）。与非当日出院患者相比，当日出院患者的住院费用（以美元计）相对较低（WMD -2587.4，95% CI：-4628.3，-546.6）。
对于患有非复杂性急性阑尾炎并接受腹腔镜阑尾切除术的儿童及青少年，当日出院与再入院风险增加、非计划急诊就诊及并发症无关。此外，当日出院与较低的住院护理费用相关。可鼓励在这部分儿童及青少年中采用当日出院。
[www.crd.york.ac.uk/prospero]，标识符[CRD420 22320539]
