O. Cheng1, L. Cheng2, S. Burjonrappa2 1Stony Brook University Medical Center,Stony Brook, NY, USA 2Montefiore Medical Center,Bronx, NY, USA
Introduction: Appendicitis has been cited to be the most common abdominal disorder that requires acute care surgery in the pediatric population. Enhanced Recovery After Surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the profound stress response following surgery. Such protocols have been found to enhance quality of care for surgical patients, as well as improve recovery and shorten hospital stays. ERAS protocols have been proven to help colorectal surgeries but there are no protocols in place yet for appendectomies in the pediatric population. The purpose of this study is to determine the key factors that facilitate same-day discharge and early return to normal activities after laparoscopic appendectomies in children.
Methods: This is a single-center retrospective chart review of pediatric patients (<18 years old) who underwent appendectomies for acute appendicitis from January 2015 to April 2017. The patient population was divided into two groups: those with same-day discharge and those who were discharged one or more days after surgery. Same day discharge (SDD) was defined as discharge less than 24 hours of surgical admission. Patient factors, including pre-hospital, pre-operative, peri-operative, and post-operative factors, were compared and analyzed between the two groups and statistically evaluated using Fisher two-test for categorical data and student t-test for continuous variables.
Results: 248 patients were found under ICD-9 and ICD-10 codes for acute appendicitis. Of these, 63 were excluded due to perforated appendicitis, non-operative management, interval appendectomies, or misdiagnosis. The remaining 185 had laparoscopic appendectomies; 59.5% (n=110) were SDDs and 40.5% (n=75) stayed more than one day. No significant difference was found for time between ER arrival and surgical admission (5.27 vs 5.38 hours; p=0.8) but SDD patients had a significantly shorter time between surgical admission and operation (5.8 vs 11.4 hours; p<0.001). SDD patients also had fewer intra/post-operative complications (1.8% vs 13%; p<0.01) and patients with complications were more likely to stay. There was no significant difference in readmission rates between the two groups (2.73% vs 2.63%; p=1). Total hospital costs were significantly less for SDD ($29,200 vs $33,700; p<0.001). See table for more values.
Conclusion: Surgical leadership can be effective in facilitating same-day discharge without increasing readmission rates or complications, and helps reduce hospital costs, decreases chances of nosocomial infection, and increases patient and family satisfaction.
