title: Resource savings and outcomes associated with outpatient laparoscopic appendectomy for nonperforated appendicitis.
abstract: BACKGROUND
  Postoperative admission for acute appendicitis utilizes health care system resources. We evaluated outcomes and hospital charges for children with nonperforated appendicitis who underwent outpatient laparoscopic appendectomy.
  
  
  METHODS
  A retrospective chart review was performed for patients ≤18years old who underwent laparoscopic appendectomy for acute appendicitis in 2015. Patients were categorized into discharge from postanesthesia care unit (PACU) (outpatient), admission for <24-h, and admission for >24-h. Continuous variables were compared using analysis of variance and categorical variables were compared using chi-square test, with p<0.05 considered significant.
  
  
  RESULTS
  Of the 171 patients identified, 63 (37%) were discharged from the PACU, 94 (55%) were admitted <24-h, and 14 (8%) were admitted >24-h. There were no differences in postoperative emergency department/clinic visits, complications, or readmissions. Hospital charges for admission <24-h and >24-h were $1007 and $2237 more per patient than the PACU-discharge group, respectively. Outpatient laparoscopic appendectomies became more common over time, occurring in only 20% of patients with acute appendicitis in the first quarter of the year versus 49% of patients in the last quarter.
  
  
  CONCLUSIONS
  Outpatient laparoscopic appendectomy for nonperforated appendicitis in children is a safe practice that decreases length of stay and hospital charges. Adoption of an outpatient strategy allows for better standardization of care and can lead to savings in health care resources.
  
  
  METHODS
  III (Treatment: retrospective comparative study).
authors.affiliation: Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA; Department of Pediatric Surgery, Arkansas Children's Hospital Research Institute, 13 Children's Way, Little Rock, AR 72202, USA. Electronic address: lgurien@gmail.com.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Gurien
authors.affiliation: Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Burford
authors.affiliation: Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA; Department of Pediatric Surgery, Arkansas Children's Hospital Research Institute, 13 Children's Way, Little Rock, AR 72202, USA.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Bonasso
authors.affiliation: Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA.
authors.forename: Melvin S
authors.initials: MS
authors.lastname: Dassinger
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D001062:Appendectomy / Q000191:economics / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000453:epidemiology* / Q000601:surgery; D001826:Body Fluids; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Appendectomy; Appendicitis; Cost; Outpatient; Pediatric; Resources