Safety of Same-Day Discharge Compared to Overnight Observation Following Laparoscopic Appendectomy in the Pediatric-Aged Patient: A National Surgical Quality Improvement Program Project

Abstract

Abstract

Background:

Previous studies regarding same-day discharge (SDD) after laparoscopic appendectomy for pediatric patients have been limited by the cohort size and lack of specificity regarding the definition of SDD. Our study evaluates the safety of appendectomy performed with SDD in pediatric patients when compared to appendectomy followed by an overnight stay, using a large nationwide database and a strict definition of SDD by using hospital length of stay (LOS).

Methods:

Using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) registry, we identified patients younger than 18 years of age who underwent outpatient laparoscopic appendectomy, with SDD (n = 2647) or overnight stay (n = 5045). One-to-one propensity score matching was performed to compare 30-day readmission rates and postsurgical complications.

Results:

Non-Hispanic black race was associated with a higher likelihood of overnight stay after laparoscopic appendectomy. In the propensity score-matched analysis (N = 2443 pairs), SDD was not associated with an increased risk of 30-day unplanned readmission (odds ratio [OR] = 0.9, 95% confidence interval [CI] = 0.6–1.4; P = .667) or any 30-day complication (OR = 0.8, 95% CI: 0.6–1.1; P = .258).

Conclusion:

SDD after laparoscopic appendectomy in pediatric patients was not associated with an increased risk of 30-day hospital admission or complication rate. Protocols to expedite perioperative care, including standardization of intraoperative care, may facilitate same-day hospital discharge, resulting in a decrease in health care costs.