title: Same-Day Discharge Following Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis as a Measure of Quality in the Pediatric Population.
abstract: BACKGROUND
  Acute appendicitis remains the most common surgical emergency in children, with laparoscopic appendectomy (LA) now the standard of care. Same-day discharge (SD) after LA is both feasible and safe in children treated for uncomplicated appendicitis. This study aims to determine if SD following LA for children with uncomplicated appendicitis would improve the quality of care with respect to cost of treatment, patient satisfaction, and complications when compared with a cohort admitted postoperatively.
  
  
  METHODS
  An IRB-approved retrospective review of children, 1-18 years old, treated with LA for uncomplicated appendicitis and eligible for same-day discharge at our hospital from August 2012 to April 2015, was performed with telephone follow-up and satisfaction survey for SD patients. Children discharged the same day postoperatively (SD) were compared with those who were admitted postoperatively and discharged the next day (ND) for baseline characteristics, complications, length of stay (LOS), and hospital charges with Student's t-test. Significance was set at P < .05.
  
  
  RESULTS
  Of 236 acute, uncomplicated appendicitis patients, 121 (51%) had SD and 115 (49%) had ND. Baseline characteristics and postoperative complications were similar, but SD was associated with shorter LOS, 11.8 ± 2.7 versus 24.8 ± 21.2 (P < .001); lower costs, $10,551 ± 2165 versus $12,691 ± 3507 (P < .0001); and good family satisfaction, with 25/32 (80%) of those surveyed opting for SD in the future.
  
  
  CONCLUSIONS
  This study shows good patient/family satisfaction following discharge from the recovery room in addition to expected cost and LOS savings, without increasing complications or shifting costs. SD could become the standard of care, improving quality and value for these patients, and a benchmark for emerging therapies.
authors.affiliation: 1 Department of Surgery, Maine Medical Center , Portland, Maine.|2 Tufts University School of Medicine , Boston, Massachusetts.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Halter
authors.affiliation: 1 Department of Surgery, Maine Medical Center , Portland, Maine.|2 Tufts University School of Medicine , Boston, Massachusetts.
authors.forename: Baird
authors.initials: B
authors.lastname: Mallory
authors.affiliation: 1 Department of Surgery, Maine Medical Center , Portland, Maine.|2 Tufts University School of Medicine , Boston, Massachusetts.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Neilson
authors.affiliation: 1 Department of Surgery, Maine Medical Center , Portland, Maine.|2 Tufts University School of Medicine , Boston, Massachusetts.
authors.forename: Monica
authors.initials: M
authors.lastname: Langer
mesh_terms: D000208:Acute Disease; D001062:Appendectomy / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011184:Postoperative Period; D011787:Quality of Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires