BAPS paper
A prospective study of safety and satisfaction with same-day discharge after laparoscopic appendectomy for acute appendicitis

https://doi.org/10.1016/j.jpedsurg.2011.11.024Get rights and content

Abstract

Background/Purpose

This study examines the safety and patient satisfaction in discharging children undergoing laparoscopic appendectomy (LapAppy) for acute appendicitis on the day of surgery.

Methods

After institutional review board approval, data were collected prospectively for 158 consecutive patients undergoing LapAppy for simple appendicitis. Time from operation to discharge and complications were analyzed. At follow-up, parents completed a satisfaction survey. The Student t test was used for statistical analysis.

Results

Laparoscopic appendectomy was performed in 158 children ranging from age 2 to 19 years (mean, 12 years) over a 6-month period. Single-port, single-instrument LapAppy was possible in 152 patients (96%). Eighty percent of patients (n = 126) were discharged on the day of surgery, a mean of 4.8 hours postoperatively (range, 1-12 hours). Of the remaining 32, 24 (75%) were admitted because the operation ended too late for postoperative discharge; 3 (9%), for medical reasons; and 5 (16%), when the families declined to leave. One hundred nine parents (87%) whose children went home postoperatively stated that they were happy with the expeditious discharge, whereas 17 (13%) felt nervous. In addition, 116 parents (92%) stated that, in retrospect, same-day discharge was preferable, whereas 10 parents (8%) were not sure that it was the best decision. None, however, would insist on admission if faced with the situation again. There were no major complications and no significant difference in the rate of umbilical wound infections for same-day discharge patients (2%) and admitted patients (3%).

Conclusion

Routine same-day discharge after pediatric LapAppy for acute appendicitis is safe, with good parent satisfaction.

Section snippets

Methods

Our institutional review board approved the study of same-day discharge after appendectomy for acute appendicitis. During the research period (July 2010-December 2010), all patients presenting with the preoperative diagnosis of acute appendicitis were placed on the outpatient appendectomy protocol. The surgical team counseled the parents before surgery that same-day discharge was expected and described the benefits of that plan of action. Patients found at operation to have perforated or

Results

Over the 6-month period, surgeons took 179 children to the operating room for presumed simple acute appendicitis at Miami Children's Hospital. Gangrene or perforation was noted in 21 children, and these were admitted for antibiotics postoperatively and excluded from further study. Laparoscopic appendectomy was performed in the remaining 158 children with a mean age of 12 (2-19) years (Table 2). Single-port, “all-in-one” appendectomy was possible in 152 children (96%) (Table 3). Two children had

Discussion

Many studies have shown that LapAppy is at least as good as open appendectomy with several patient outcome benefits, including less postoperative pain and shorter LOS [3], [11], [12], [13]. Additional advantages include lower costs, particularly with increasing operative experience leading to shorter operative times [14] and reusable equipment obviating the need for expensive disposable supplies [3], [4]. Lastly, LapAppy may allow a shorter recovery time, returning patients to a productive

References (18)

There are more references available in the full text version of this article.

Cited by (79)

  • Same-day discharge after appendectomy for uncomplicated appendicitis in children: Potential barriers to increased utilization

    2022, American Journal of Surgery
    Citation Excerpt :

    The provision of high-value care for acute appendicitis in children is an impactful area in which to focus quality improvement efforts in the field of pediatric surgery.4 The findings of this study lend additional support to prior work suggesting that SDD is a safe and effective approach to decrease resource utilization among children with uncomplicated appendicitis.3,5–11,14–16,18,22–24 Parent and patient satisfaction has also been satisfactory with use of SDD.5,18,24,25

  • Advances in the Diagnosis and Management of Appendicitis in Children

    2021, Advances in Surgery
    Citation Excerpt :

    High caregiver satisfaction has been associated with same-day discharge protocols. In one prospective study of 158 patients, when asked at their 2-week follow-up visit, 92% of parents would choose same-day discharge again [51]. Duration and amount of prescribed opioids have been shown to be highly variable in children with appendicitis, and narcotic prescription has been associated with increased odds of emergency department revisit (13% vs 4.3%) and constipation requiring medical attention (2.1% vs 0%) in a retrospective study of 590 patients [52].

  • Appendicitis

    2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
View all citing articles on Scopus

Presented at the 58th Annual Meeting of the British Association of Paediatric Surgeons, Belfast, Northern Ireland, July 20-22, 2011.

View full text