Same-day discharge after uncomplicated appendectomy in kids safe: study

Last Updated: 2017-07-12

By Reuters Staff

NEW YORK (Reuters Health) - Children who undergo appendectomy for acute nonperforated appendicitis can be safely discharged on the same day as the surgery, a new study shows.

With same-day discharge, there was no increase in 30-day hospital readmissions compared with discharge within two days postop, the study team found.

“Appendectomy is the most common abdominal operation performed in pediatric patients in the United States. Studies in adults have suggested that same-day discharge after appendectomy is safe and does not result in higher-than-expected hospital readmissions,” Dr. Sarah Cairo of Women's and Children's Hospital Buffalo, New York, and colleagues explain in their report online July 5 in JAMA Surgery.

To see if this is also the case in children, they did a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program–Pediatric database, which provides “high-quality” surgical outcomes data from more than 80 participating U.S. hospitals.

Among 20,981 patients (61% male, mean age 11), 4,662 (22.2%) had same-day discharge and 16,319 (77.8%) were discharged within one or two days after surgery.

According to the investigators, the odds of readmission was no different for patients discharged on the day of surgery and those discharged within two days of surgery (adjusted odds ratio 0.82; 95% CI, 0.51 to 1.04; P=0.06). The readmission rate was 1.89% with same-discharge and 2.33% with later discharge.

There was also no difference in the wound complication rate between patients with same-day discharge and those discharged within two days after surgery (adjusted odds ratio 0.75; 95% CI, 0.56 to 1.01; P=0.06).

This study shows that “when applied to the appropriate patients, same-day discharge is a safe alternative to overnight admission after appendectomy in a pediatric patient,” the authors conclude.

Same-day discharge, they add, “may be an applicable quality metric in pediatric patients undergoing appendectomy for simple appendicitis."

Dr. Cairo did not respond to a request for comment by press time.

A related paper in JAMA Surgery July 5 looks at outcomes and costs of managing appendicitis in safety-net hospitals, which serve vulnerable populations with limited resources.

In this large database review, safety-net hospitals treated higher numbers of cases of perforated appendicitis, yet maintained similar rates of morbidity and costs as other hospitals, report Dr. Steven Lee, of Harbor-University of California Los Angeles Medical Center in Torrance, and colleagues.

These findings suggest that safety-net hospitals “may be well equipped to perform common, urgent general surgical procedures such as appendectomy,” they conclude.

SOURCE: http://bit.ly/2tMCefi and http://bit.ly/2sPLb6p

JAMA Surg 2017.