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Same Day Appendectomy in Children is Safe with Good Parent Satisfaction
*Fuad Alkhoury, *Cathy A Burnweit, *Leopoldp Malvezzi, *Colin G Knight, *Jeannette Diana, *Raquel Pasaron, *Joanne Mora, *Pradeep Nazarey, *Alexandra Aserlind, *Steven Stylianos
Miami Children's Hospital, Miami, FL
To examine the safety and parent satisfaction of same day discharge in children undergoing laparoscopic appendectomy
Prospective cohort study
A tertiary care children's hospital
During the study period, 7/1/2010 and 1/1/2011, children younger than 18 years (n=207) were identified preoperatively for possible same day discharge following acute or interval appendectomy. The all-in-one single port single instrument was used in 198 patients (96%).
Same day appendectomy vs overnight stay
Main Outcome Measures:
Adverse event rates and parent satisfaction
Of 207 consecutive children undergoing acute (n=186) or interval (n=21) appendectomy, 162 (78%) were discharged on the same day of surgery. The remaining 45 patients were admitted overnight. In 35 (78%) patients, the hour was too late for discharge, in 9 (20%) medical indications dictated admission and one stayed secondary to social reasons. Post-operative pain control was achieved in all patients using oral medications. Compared with admitted patients, same day discharges had similar complication rates (8% vs 7% in the admitted group, p >0.05), similar number of postoperative visits to the emergency room (6% vs 5%, p>0.05) and equivalent readmission rates (2%). Same-day discharges had a mean reduced length of stay (5 vs 16 hours, p < 0.05). Most parents (141, 87%) stated they were happy with the expeditious discharge, while 13 (8%) felt nervous but were ultimately satisfied. Seven parents (4%), in retrospect, were not sure early discharge was best. Only one parent would insist on admission if faced with the situation again.
Routine same day appendectomy in children appears safe and has good parent satisfaction. Further refinement of an efficacious surgical pathway is in order.
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