T. A. Oyetunji1, E. M. Knott1, A. Desai1, B. Dalton1, K. W. Schnell1, J. J. Dehmer1, P. Aguayo1, B. C. Nwomeh2 1Children’s Mercy Hospital- University Of Missouri Kansas City,Surgery,Kansas City, MO, USA 2Nationwide Children’s Hospital,Columbus, OH, USA
Introduction:
Recent single institutional data point to the feasibility of same day discharge (SDD) after appendectomy for non-perforated appendicitis and its potential as a quality indicator of care. Also the opportunities for SDD are greatest the sooner the appendectomy is performed after admission. We examine a national database to assess the pattern of utilization of SDD among children that had an appendectomy on the same day.
Methods:
The 2009 Kids Inpatient Database (KID) was queried for children with a diagnosis of acute appendicitis. All perforated appendicitis and those with no procedure code for open or laparoscopic appendectomy were excluded. Day from admission to procedure day and total length of stay (LOS) were then analyzed by demographics, type of procedure (laparoscopic vs. open), children’s hospital designation and hospital region. After stratifying all patients udergoing appendectomy on day of admission into 2 groups by LOS (<=1 day vs. >1 day), a multivariate analysis was this subset to determine the predictors of prolonged LOS (>1day).
Results:
A total of 51,133 records, representing a weighed estimate of 73,956 patients with a diagnosis of non perforated appendicitis were analyzed of which 76% met the inclusion criteria of admission day appendectomy. Median age was 14 yrs with inter-quartile range (IQR) of 10- 17yrs. Median LOS was 1 day (IQR 1-2 days) and the majority (71.8%), had laparoscopic appendectomy. On adjusted analysis, laparoscopic cases were 50% less likely to be discharged later compared to their open counterparts (OR 0.50, 95% CI 0.47-0.53). Compared to Whites, significantly more Hispanics (OR 1.44, 95% CI 1.36-1.56) and African Americans (OR 1.57, 95% CI 1.42-1.73) had a LOS > 1 day. Table 1 shows the SDD rates based on children’s hospital designation and hospital region.
Conclusion:
SDD is increasingly utilized for children with non-perforated appendicitis, but there is significant variability in the utilization of SDD for different ethnicities and hospital regions. Also, these data demonstrate that SDD is more likely to occur the sooner an appendectomy is performed after admission for non-perforated appendicitis. Further research is still required.
