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Original Investigation
July 5, 2017

Association of Same-Day Discharge With Hospital Readmission After Appendectomy in Pediatric Patients

Author Affiliations
  • 1Pediatric Surgery, Women and Children’s Hospital of Buffalo, Buffalo, New York
  • 2Department of Pediatric Surgery, Children’s Healthcare of Atlanta, Atlanta, Georgia
  • 3Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
  • 4Department of Pediatric Surgery, Lehigh Valley Children’s Hospital, Allentown, Pennsylvania
  • 5Department of Surgery, University at Buffalo, Buffalo, New York
JAMA Surg. Published online July 5, 2017. doi:10.1001/jamasurg.2017.2221
Key Points

Question  Is same-day discharge following an appendectomy for acute, nonperforated appendicitis safe in the pediatric population?

Findings  In this cohort study of 22 771 pediatric patients who underwent appendectomy for acute, nonperforated appendicitis, same-day discharge was not associated with an increase in 30-day hospital readmissions compared with discharge 1 or 2 days after surgery.

Meaning  With appropriate patient selection, same-day discharge after appendectomy may be safe for pediatric patients and may be a valuable quality metric for the provision of safe and efficient surgical care.

Abstract

Importance  Appendectomy is the most common abdominal operation performed in pediatric patients in the United States. Studies in adults have suggested that same-day discharge (SDD) after appendectomy is safe and does not result in higher-than-expected hospital readmissions.

Objective  To evaluate the influence of SDD on 30-day readmission rates following appendectomy for acute appendicitis in pediatric patients.

Design, Setting, and Participants  This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program–Pediatric database to evaluate 30-day readmission rates among pediatric patients who underwent an appendectomy for acute, nonperforated appendicitis. The database provides high-quality surgical outcomes data from more than 80 participating US hospitals, including free-standing pediatric facilities, children’s hospitals, specialty centers, children's units within adult hospitals, and general acute care hospitals with a pediatric wing. Patients selected for inclusion (n = 22 771) were between ages 0 and 17 years and underwent appendectomy for uncomplicated appendicitis between January 1, 2012, and December 31, 2015. Patients excluded were those discharged more than 2 days after surgery.

Exposures  Same-day discharge after appendectomy or discharge 1 or 2 days after surgery.

Main Outcomes and Measures  The primary outcome was 30-day readmission. Secondary outcomes included surgical-site infections and other wound complications.

Results  Of the 20 981 patients, 4662 (22.2%) had SDD and 16 319 (77.8%) were discharged within 1 or 2 days after surgery. The patient cohort included 12 860 boys (61.3%) and 8121 girls (38.7%), with a mean (SD) age of 11.0 (3.56) years. There was no difference in the odds of readmission for patients with SDD compared with those discharged within 2 days (adjusted odds ratio [aOR], 0.82; 95% CI, 0.51-1.04; P = .06; readmission rate, 1.89% vs 2.33%). There was no significant difference in reason for readmission on the basis of discharge timing. Likewise, there was no difference in wound complication rate between patients with SDD and those discharged 1 or 2 days after surgery (aOR 0.75; 95% CI, 0.56-1.01; P = .06).

Conclusions and Relevance  In pediatric patients with acute appendicitis undergoing appendectomy, SDD is not associated with an increase in 30-day hospital readmission rates or wound complications when compared with discharge 1 or 2 days after surgery. Same-day discharge may be an applicable quality metric for the provision of safe and efficient care for pediatric patients with acute, nonperforated appendicitis.

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