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Same-day discharge safe after laparoscopic appendectomy
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Acute appendicitis patients who are discharged on the same day after laparoscopic appendectomy have similar rates of postoperative complications and readmissions compared with patients who are hospitalized overnight, according to recent study results.
Further, same-day discharge resulted in a mean direct cost savings of $348 per patient.
“Advances in early recognition and treatment of the disease process and minimally invasive techniques have allowed for some of the inflammatory response and the trauma from surgical treatment to be lessened and recovery to be faster; as a result, patients can get back to their lives much sooner,” Armen Aboulian, MD, FACS, a colorectal surgeon at Kaiser Permanente, Woodland Hills, California, said in a press release. “Now up to 60% of non-perforated acute appendicitis patients at Kaiser Permanente are treated without an overnight stay.”
Aboulian and colleagues retrospectively studied 12,703 adults with acute, non-perforated appendicitis who underwent laparoscopic appendectomy at 14 Kaiser Permanente medical centers in southern California between 2010 and 2014.
Patients aged older than 50 years, those with diabetes or hypertension, and those whose surgery was performed later in the day were more likely to be hospitalized overnight.
The researchers found that patients who were discharged on the same day (n = 6,710) had a lower 30-day readmission rate than those who were hospitalized overnight (n = 5,993; 2.2% vs. 3.1%; P < .005).
In addition, both groups had comparable rates of postoperative visits to the ED or radiology department for diagnostic or therapeutic imaging studies.
Finally, patients who were hospitalized overnight had a slightly higher rate of postoperative visits to the general surgery department (85% vs. 81%; P < .001).
“In general, recovery at home is preferred by most patients and sleeping in your own bed has benefits that are difficult to measure,” Aboulian said in the press release. “At the same time, the goal of the study is not to rush the patients home, but rather, the importance of this study lies in the confirmation that discharge from the recovery room is safe and surgeons across the nation may consider it directly from the recovery room in the appropriate setting.”
Aside from safety outcomes, the study also showed that patients who were discharged on the same day had a lower direct hospital cost compared with those who were hospitalized overnight ($1,994 vs. $2,343; P < .001). This could translate to a potential annual savings of $921,500,000 to the U.S. health care system, according to the press release.
“This study is significant because it demonstrates that patients may be treated safely with surgery and discharged on the same day as the operation,” Aboulian concluded in the press release. “Two hundred years ago, the diagnosis of appendicitis had more than a 60% mortality rate. Now these patients are treated and don’t even have to spend the night in the hospital. Medical treatment for this disorder has come a long way.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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