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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

Objectives:
To examine the safety and parent satisfaction of same day discharge in children undergoing laparoscopic appendectomy
Design:
Prospective cohort study
Setting:
A tertiary care children's hospital
Patients:
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%).
Interventions:
Same day appendectomy vs overnight stay
Main Outcome Measures:
Adverse event rates and parent satisfaction
Results:
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.
Conclusions:
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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