title: Same-day discharge after appendectomy results in cost savings and improved efficiency.
abstract: Appendectomy incurs significant costs for the healthcare system. There is evidence that patients can be safely discharged the same day after appendectomy. The purpose of this study was to develop an evidence-based protocol for same-day discharge after appendectomy. A fast-track surgery protocol was developed for same-day discharge after appendectomy. This was prospectively applied to all patients presenting for appendectomy from July 2012 to June 2013. Demographics, clinical measures, and outcomes were measured. Of 206 patients eligible for same-day discharge, 185 (90%) were successfully discharged according to the protocol. The mean length of stay after appendectomy was 3.1 ± 1.4 hours. Protocol implementation reduced inpatient use from 99 to 53 per cent. Patient transfers were reduced, resulting in 40 per cent fewer handoffs. The decreased use of hospital resources resulted in a median reduction of hospital charges of $4111 per patient. The complication rate for patients discharged the same day was 2.7 per cent. Appendectomy for acute appendicitis or interval appendectomy can be performed safely as same-day surgery. Implementation of this protocol resulted in optimization of resource use by reducing inpatient admissions, decreasing handoffs, and reducing hospital costs.
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg, Florida, USA.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Farach
authors.forename: Paul D
authors.initials: PD
authors.lastname: Danielson
authors.forename: N Elizabeth
authors.initials: NE
authors.lastname: Walford
authors.forename: Richard P
authors.initials: RP
authors.lastname: Harmel
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Chandler
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000191:economics*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D017046:Cost Savings; D017598:Efficiency, Organizational; D019317:Evidence-Based Medicine; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D010351:Patient Discharge / Q000191:economics*; D011446:Prospective Studies; D055815:Young Adult