Jukić Miro, Tesch Alexander, Todorić Jakov, Šušnjar Tomislav, Milunović Klaudio Pjer, Barić Tomislav, Pogorelić Zenon
Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia.
Department of Surgery, School of Medicine, University of Split, Šoltanska 2, 21 000 Split, Croatia.
Children (Basel). 2022 Aug 12;9(8):1220. doi: 10.3390/children9081220.
(1) Background: One-day surgery has been widely adopted for many elective laparoscopic procedures in pediatric patients. Recently, the same protocol has been investigated for some emergency procedures, such as laparoscopic appendectomy. This study aimed to evaluate the safety and effectiveness of discharge from hospital within 24 h in pediatric patients who received laparoscopic appendectomy for uncomplicated acute appendicitis. (2) Methods: From 1 March 2021 to 1 May 2022, a total of 180 pediatric patients who were discharged from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis were included in this prospective single-center study. The primary outcome of this study was the safety of discharge from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis, as well as the parental satisfaction with this protocol. Secondary outcomes included the rate of readmission or unplanned return to the operating room, the complication rate and a cost-effectiveness analysis. For each patient, demographic data, preoperative evaluation (physical examination, laboratory data, imaging), duration of surgery, intraoperative and postoperative complications, length of hospital stay and pain levels, as well as parental satisfaction with this protocol, were recorded. (3) Results: The median age was 11 years (interquartile range (IQR) 10, 14). The majority of the patients (63.8%) were males. The median length of hospital stay after surgery was 15 h (IQR 12, 19). The highest level of satisfaction, at discharge, was recorded in most of the respondents ( = 155, 86.1%), while the remaining 25 (13.9%) expressed moderate levels of satisfaction. The median pain levels according to a visual analogue scale for all postoperative days were low (range 0-4). In four patients (2.2%), unplanned readmission before the seventh postoperative day because of postoperative intraabdominal abscess was recorded. All patients with abscess formation were treated conservatively. The majority of the parents ( = 175; 97.2%) expressed the highest level of satisfaction during the outpatient follow-up examination on the seventh postoperative day. (4) Conclusions: Same-day discharge after laparoscopic appendectomy for simple appendicitis in pediatric patients was safe and feasible. Parental satisfaction with this protocol was very high. With the right protocol and parent education, pediatric patients who underwent laparoscopic appendectomy because of non-complicated acute appendicitis may be successfully treated in this way.
（1）背景：一日手术已在小儿患者的许多择期腹腔镜手术中广泛采用。最近，该方案也被用于一些急诊手术，如腹腔镜阑尾切除术。本研究旨在评估因单纯性急性阑尾炎接受腹腔镜阑尾切除术的小儿患者在24小时内出院的安全性和有效性。（2）方法：2021年3月1日至2022年5月1日，本前瞻性单中心研究纳入了180例因单纯性阑尾炎接受腹腔镜阑尾切除术后24小时内出院的小儿患者。本研究的主要结局是单纯性阑尾炎腹腔镜阑尾切除术后24小时内出院的安全性以及家长对该方案的满意度。次要结局包括再入院率或非计划返回手术室的发生率、并发症发生率和成本效益分析。记录每位患者的人口统计学数据、术前评估（体格检查、实验室数据、影像学检查）、手术时长、术中及术后并发症、住院时间和疼痛程度，以及家长对该方案的满意度。（3）结果：中位年龄为11岁（四分位间距（IQR）为10, 14）。大多数患者（63.8%）为男性。术后中位住院时间为15小时（IQR为12, 19）。大多数受访者（n = 155, 86.1%）在出院时表示满意度最高，而其余25例（13.9%）表示满意度中等。所有术后天数根据视觉模拟量表的中位疼痛程度较低（范围为0 - 4）。4例患者（2.2%）术后第7天前因术后腹腔内脓肿非计划再入院。所有脓肿形成的患者均接受保守治疗。大多数家长（n = 175; 97.2%）在术后第7天门诊随访检查时表示满意度最高。（4）结论：小儿患者因单纯性阑尾炎接受腹腔镜阑尾切除术后当日出院是安全可行的。家长对该方案的满意度非常高。通过正确的方案和家长教育，因非复杂性急性阑尾炎接受腹腔镜阑尾切除术的小儿患者可以通过这种方式得到成功治疗。
