B. G. Dalton1, K. W. Schnell1, E. M. Knott1, S. D. St. Peter1, P. Aguayo1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Pediatric Surgery,Kansas City, MO, USA
Introduction: Although historically thought to be a fairly uncommon problem in the pediatric population, gallbladder disease, symptomatic cholelithiasis (SC) and biliary dyskinesia (BD) in particular, is being increasingly diagnosed in the pediatric population. In the United States, the accepted surgical approach for symptomatic gallbladder disease in both adults and in children has been laparoscopy. While the safety of same day discharge (SDD) after laparoscopic cholecystectomy (LC) in adults has been well documented in the literature, the same data in the pediatric population is lacking. We have recently instituted a protocol for SDD after LC for SC and BD and this study is an analysis of our initial experience.
Methods: A retrospective chart review of all patients who underwent laparoscopic cholecystectomy for BD and SC in our institution from January 2011 to July 2014 was performed. Time from operation to discharge, reason for overnight stay, complications, readmissions, and follow-up prior to scheduled appointment were analyzed. The Student t test was used for statistical analysis.
Results: A total of 227 laparoscopic cholecystectomies were performed for SC and BD during the study period. Approximately 25% (n=57) of patients were discharged on the day of surgery. The remaining 75% (n=170) of patients were admitted at least one night for the following reasons: medical 16.5% (n=28), surgery ending too late 4.1% (n=7) or clinical care habits 79.4% (n=135). Comparing patients that were discharged the same day with patients that stayed overnight, no differences were found in complication rate (3.5% vs 5.8%, P=0.44), readmissions (5.3% vs 1%, P=0.12) or follow up prior to scheduled appointment (3.5% vs 2.9%, P=0.84). Length of stay was significantly less for the SDD group than the inpatient group (4.1h vs 26.8h, p<.01). A trend for more SDDs was observed as time elapsed from initiation of the protocol. From January 2013 (the month of the first SDD) through September 2013, 34% (18/53) of pts undergoing LC were discharged the same day. October 2013 through July 2014, 55% (36/69) of patients were sent home the same day. Also, earlier completion of surgery trended toward SDD (figure).
Conclusion: Same day discharge appears safe for pediatric patients undergoing laparoscopic cholecystectomy for BD or SC. The main obstacles to discharge were time of surgery completion and clinical care habits, both of which improved as comfort level with SDD grew among the staff.
