Same Day Versus Next Day Appendectomy: An Assessment of outcomes in 50,093 patients
James M Healy, Robert Cowles, *Doruk Ozgediz, Emily Christison-Lagay, *David Stitelman, Michael G. Caty, *Daniel G. Solomon
Yale, New Haven, CT
Objective: Major complications following pediatric appendectomy are rare, therefore a population-level study is necessary for adequate power to detect outcome differences between patients who undergo appendectomy on hospital day 0 (HD0) or day 1 (HD1). In this study, a large administrative database is employed to identify if complications, length of stay, and charges are different when appendectomy is performed on HD1 versus HD0.
Design: Retrospective analysis-2012 Kidsí Inpatient Database
Setting: National sample
Patients: Pediatric inpatients
Main Outcome Measures: Postoperative complications, percutaneous drain placement, TPN, central line placement, discharge with services, length of stay, mortality, total charges.
Results: From 3,200,000 admissions, incidental appendectomies were excluded and only cases of acute appendicitis with and without peritonitis (ICD-9 540.0 and 540.9) where appendectomy was performed on HD0 or HD1 were included (N=50,093). Of these 50,093 cases, 80% were performed on HD0 (n=40,097) and 20% on HD1 (n=9,996). No significant differences were identified in rates of sepsis, ileus, wound complications, or mortality. Rates of urinary complications [OR=1.38 (1.18-1.62), p<0.001), hemorrhage [OR=1.68 (1.40-2.03), p<0.001), pulmonary complications [OR=1.38 (1.14-1.67), p=0.001), percutaneous drain placement [OR=1.48 (1.11-1.98), p<0.001), TPN [OR=2.47 (2.00-3.06), p<0.001), central line [OR=2.51 (2.14-2.94), p<0.001), need for services [OR=1.32 (1.07-1.65), p=0.011), length of stay (3.0 vs. 2.1 days, p<0.001), and total charges ($33,988 vs. $29,970, p<0.001) were significantly increased in patients with appendectomy on HD1.
Conclusions: The optimal timing of appendectomy remains unsettled. Patients who underwent appendectomy on HD1 instead of HD0 accrued longer lengths of stay, higher charges and more complications. However, this correlation between surgical timing and outcomes cannot imply causality, and multicenter prospective controlled studies would be required to further explore this issue.
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