Routine same-day discharge after acute or interval appendectomy in children: a prospective study.
OBJECTIVE
The outcomes of and parental satisfaction with same-day discharge in children undergoing laparoscopic appendectomy warrant making it the usual and customary pathway.


METHODS
Prospective cohort study.


METHODS
Tertiary care children's hospital.


METHODS
Between July 1, 2010, and March 30, 2011, a total of 207 children were considered for same-day discharge after acute or interval laparoscopic appendectomy. The all-in-one single-incision single-instrument technique was used in 95.7% of children.


METHODS
Same-day discharge vs overnight admission.


METHODS
Operative details, postoperative length of stay, adverse events, and parental satisfaction.


RESULTS
Of 207 consecutive children undergoing acute (n = 186) or interval (n = 21) appendectomy, 162 (78.3%) were discharged on the day of surgery. The remaining 45 children were admitted overnight because the hour was too late for discharge in 35 (77.8%), medical indications dictated admission in 5 (11.1%), and social reasons required admission in 5 (11.1%). In all the children, oral medication alone was used for postoperative pain. The complication rates were similar in the same-day discharge group (8.0%) and in the admitted group (6.6%), as were the rates of urgent postoperative visits (7.4% vs 4.4%%) and the readmission rates (2.5% vs 2.2%) (P > .05 for all). The same-day discharge group had a reduced postoperative length of stay compared with the admitted group (mean, 5 vs 16 hours, P < .05). At the time of discharge, most parents (87.0%) stated they were happy with the expeditious discharge, whereas 8.0% indicated they felt nervous but were ultimately satisfied. In retrospect, 8 of 162 parents (4.9%) were not sure early discharge was best, but only 1 parent would insist on admission if faced with the situation again.


CONCLUSIONS
Routine same-day discharge after pediatric appendectomy seems safe, with good parental satisfaction.
Department of Pediatric Surgery, Miami Children’s Hospital, Florida International University College of Medicine, Miami, FL 33155, USA.
Fuad
F
Alkhoury
Leopoldo
L
Malvezzi
Colin G
CG
Knight
Jeannette
J
Diana
Raquel
R
Pasaron
Joanne
J
Mora
Alexandra
A
Aserlind
Steven
S
Stylianos
Cathy
C
Burnweit
D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D001062:Appendectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010351:Patient Discharge; D011446:Prospective Studies; D055815:Young Adult