University at Buffalo Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, 14215, USA.
University at Buffalo Division of Pediatric Surgery, Jacobs School of Medicine and Biomedical Sciences, 1001 Main St, Buffalo, NY, 14215, USA.
Pediatr Surg Int. 2024 Nov 2;40(1):287. doi: 10.1007/s00383-024-05869-9.
Practice patterns of same-day discharge for pediatric laparoscopic appendectomy for non-perforated appendicitis are not well-analyzed. Our aim is to evaluate current practice patterns and outcomes of same-day discharge for these patients.
NSQIP-P retrospective registry identified patients (2017-2021) who underwent laparoscopic appendectomy for non-perforated appendicitis. Annual same-day discharge (SDD) rate was determined. SDD patients were compared to those discharged postoperative days 1-2 (non-SDD). Sub-group analysis was performed on ICD-10 code K35.30. Regression was performed.
Overall, 67,214 patients were identified. The SDD rate increased from 33.3% (2017) to 52.5% (2021) with decreased 30-day readmissions between SDD and non-SDD (1.3% vs 2.1%, p < 0.001). Sub-group analysis identified 7,330 patients with SDD rates from 50.7% (2019) to 60.4% (2021) with decreased 30-day readmissions (1.3% vs 2.1%, p < 0.001) for SDD versus non-SDD. No increase in adverse events for SDD occurred in either analysis. Regression identified esophageal/gastric/intestinal diseases increased odds of early readmission or reoperation (OR 1.85, p = 0.042).
Same-day discharge after pediatric laparoscopic appendectomy for non-perforated acute appendicitis continues to increase in frequency without a significant increase in adverse outcomes. SDD rates are 20-30% lower than previously published single-center studies, indicating there is a likely a larger percentage of patients that could discharge same-day.
LEVEL OF EVIDENCE (I-V): Level III.
对于非穿孔性阑尾炎的小儿腹腔镜阑尾切除术，当日出院的实践模式尚未得到充分分析。本研究旨在评估这些患者当日出院的现行实践模式和结果。
利用 NSQIP-P 回顾性登记，确定了 2017 年至 2021 年间接受非穿孔性阑尾炎腹腔镜阑尾切除术的患者。确定了每年的当日出院（SDD）率。将 SDD 患者与术后第 1-2 天出院的患者（非 SDD）进行比较。对 ICD-10 编码 K35.30 进行了亚组分析。进行了回归分析。
共确定了 67214 例患者。SDD 率从 2017 年的 33.3%（2017 年）增加到 2021 年的 52.5%（2021 年），SDD 和非 SDD 之间的 30 天再入院率从 1.3%下降到 2.1%（p < 0.001）。亚组分析确定了 7330 例 SDD 患者，其 SDD 率从 2019 年的 50.7%（2019 年）上升至 2021 年的 60.4%（2021 年），30 天再入院率从 1.3%下降到 2.1%（p < 0.001）。在这两种分析中，SDD 均未增加不良事件的发生。回归分析确定食管/胃/肠道疾病增加了早期再入院或再次手术的几率（OR 1.85，p = 0.042）。
对于非穿孔性急性阑尾炎的小儿腹腔镜阑尾切除术，当日出院的频率继续增加，而不良结果并未显著增加。SDD 率比之前发表的单中心研究低 20-30%，这表明可能有更大比例的患者可以当日出院。
证据水平（I-V）：III 级。
