title: Variability in same-day discharge for pediatric appendicitis.
abstract: BACKGROUND
  Recent single-institutional data point to the feasibility of same-day discharge (SDD) after appendectomy for nonperforated appendicitis and its potential as a quality-of-care indicator. Opportunities for SDD are greatest the sooner the appendectomy is performed after admission. We examine a national database to assess the pattern of SDD utilization among children who underwent appendectomy on the day of admission and potential limitations to SDD.
  
  
  METHODS
  The 2009 Kids Inpatient Database (KID) was queried for children with a diagnosis of acute appendicitis who had appendectomy. Exclusion criteria included those children with perforated appendicitis or those in whom the procedure code was missing. Day from admission to procedure day and total length of stay (LOS) were then analyzed by demographics, type of procedure (laparoscopic versus open), children's hospital designation, and hospital region. After stratifying all patients undergoing appendectomy on day of admission into two groups by LOS (≤1 d, SDD versus >1 d, non-SDD), a multivariate analysis was then performed to determine the predictors of SDD.
  
  
  RESULTS
  A total of 38,959 records, representing a weighted estimate of 56,077 patients with a diagnosis of nonperforated appendicitis, met the inclusion criteria. Median age was 14 y with interquartile range of 10-17 y. Median LOS was 1 d (interquartile range, 1-2 d), and the majority (71.8%) had laparoscopic appendectomy. On adjusted analysis, laparoscopic cases were 50% less likely to be non-SDD compared with their open counterparts (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.47-0.53). Compared with Caucasians, significantly more Hispanics (OR, 1.44; 95% CI, 1.36-1.56) and African Americans (OR, 1.57; 95% CI, 1.42-1.73) were non-SDD. Hospitals in the midwest and south were more likely to be non-SDD.
  
  
  CONCLUSIONS
  SDD is increasingly used for children with nonperforated appendicitis, but there is significant variability in the utilization of SDD for different ethnicities and hospital regions. These variations need to be further investigated to better delineate its potential role as a quality-of-care indicator.
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri. Electronic address: taoyetunji@cmh.edu.
authors.forename: Tolulope A
authors.initials: TA
authors.lastname: Oyetunji
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Dani O
authors.initials: DO
authors.lastname: Gonzalez
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Pablo
authors.initials: P
authors.lastname: Aguayo
authors.affiliation: Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
mesh_terms: D000293:Adolescent; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D001062:Appendectomy / Q000379:methods / Q000706:statistics & numerical data; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: Appendicitis; Pediatric; Same-day discharge