Same-Day Discharge after Non-Perforated Laparoscopic Appendectomy Is Safe
Purpose: Several single-center studies have demonstrated same-day discharge (SDD) to be safe in adults undergoing laparoscopic appendectomy (LA) for non-perforated appendicitis (NPA). The proportion of SDD appendectomy patients nationally is unknown. We sought to identify the incidence of SDD among...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2021-03-01
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| Series: | Journal of Investigative Surgery |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/08941939.2019.1630065 |
| _version_ | 1827817396756283392 |
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| author | Areg Grigorian Catherine M. Kuza Sebastian D. Schubl Ninh T. Nguyen Christian de Virgilio Dennis Kim Michael Lekawa Jeffry Nahmias |
| author_facet | Areg Grigorian Catherine M. Kuza Sebastian D. Schubl Ninh T. Nguyen Christian de Virgilio Dennis Kim Michael Lekawa Jeffry Nahmias |
| author_sort | Areg Grigorian |
| collection | DOAJ |
| description | Purpose: Several single-center studies have demonstrated same-day discharge (SDD) to be safe in adults undergoing laparoscopic appendectomy (LA) for non-perforated appendicitis (NPA). The proportion of SDD appendectomy patients nationally is unknown. We sought to identify the incidence of SDD among patients undergoing LA after NPA hypothesizing a similar risk of complications including superficial surgical site infections (SSSIs), post-operative intra-abdominal abscess, and 30-day readmission rates. Materials and methods: The 2016–2017 ACS-NSQIP Procedure-Targeted Appendectomy database was queried for adults undergoing LA with no intraoperative findings of perforation or abscess. Patients with SDD were compared to those discharged within two days. A multivariable logistic regression model was used for analysis. Results: From 16,931 patients undergoing LA, 3988 (23.6%) were SDD. Compared to those with a longer hospital stay, patients with SDD were of similar age (p = 0.29) and less likely to have a contaminated wound-class (58.5% vs. 62.6%, p < 0.001). After adjusting for age and comorbidities, patients with SDD had a similar risk of 30-day readmission (p = 0.088) and post-operative abscess (p = 0.739) but lower risk of SSSI (OR: 0.48, 0.28–0.82, p = 0.008), compared to those discharged within two days. Conclusions: Nearly a quarter of patients with NPA undergoing LA are discharged the same day. The risk of 30-day readmission is similar compared to those with a longer index hospital stay. Interestingly, the risk of SSSI is lower, however this may be related to differences in wound classification and/or selection bias. Regardless, SDD for NPA patients appears safe and should be utilized whenever possible. |
| first_indexed | 2024-03-12T00:33:41Z |
| format | Article |
| id | doaj.art-f4fabbbdf73e4499b3dcb20fd93f7d8d |
| institution | Directory Open Access Journal |
| issn | 0894-1939 1521-0553 |
| language | English |
| last_indexed | 2024-03-12T00:33:41Z |
| publishDate | 2021-03-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Investigative Surgery |
| spelling | doaj.art-f4fabbbdf73e4499b3dcb20fd93f7d8d2023-09-15T10:07:30ZengTaylor & Francis GroupJournal of Investigative Surgery0894-19391521-05532021-03-0134327027510.1080/08941939.2019.16300651630065Same-Day Discharge after Non-Perforated Laparoscopic Appendectomy Is SafeAreg Grigorian0Catherine M. Kuza1Sebastian D. Schubl2Ninh T. Nguyen3Christian de Virgilio4Dennis Kim5Michael Lekawa6Jeffry Nahmias7University of California, IrvineUniversity of Southern CaliforniaUniversity of California, IrvineUniversity of California, IrvineUniversity of California, Los Angeles – HarborUniversity of California, Los Angeles – HarborUniversity of California, IrvineUniversity of California, IrvinePurpose: Several single-center studies have demonstrated same-day discharge (SDD) to be safe in adults undergoing laparoscopic appendectomy (LA) for non-perforated appendicitis (NPA). The proportion of SDD appendectomy patients nationally is unknown. We sought to identify the incidence of SDD among patients undergoing LA after NPA hypothesizing a similar risk of complications including superficial surgical site infections (SSSIs), post-operative intra-abdominal abscess, and 30-day readmission rates. Materials and methods: The 2016–2017 ACS-NSQIP Procedure-Targeted Appendectomy database was queried for adults undergoing LA with no intraoperative findings of perforation or abscess. Patients with SDD were compared to those discharged within two days. A multivariable logistic regression model was used for analysis. Results: From 16,931 patients undergoing LA, 3988 (23.6%) were SDD. Compared to those with a longer hospital stay, patients with SDD were of similar age (p = 0.29) and less likely to have a contaminated wound-class (58.5% vs. 62.6%, p < 0.001). After adjusting for age and comorbidities, patients with SDD had a similar risk of 30-day readmission (p = 0.088) and post-operative abscess (p = 0.739) but lower risk of SSSI (OR: 0.48, 0.28–0.82, p = 0.008), compared to those discharged within two days. Conclusions: Nearly a quarter of patients with NPA undergoing LA are discharged the same day. The risk of 30-day readmission is similar compared to those with a longer index hospital stay. Interestingly, the risk of SSSI is lower, however this may be related to differences in wound classification and/or selection bias. Regardless, SDD for NPA patients appears safe and should be utilized whenever possible.http://dx.doi.org/10.1080/08941939.2019.1630065appendicitissurgical site infectionsame day surgeryoutpatientambulatoryappendectomy |
| spellingShingle | Areg Grigorian Catherine M. Kuza Sebastian D. Schubl Ninh T. Nguyen Christian de Virgilio Dennis Kim Michael Lekawa Jeffry Nahmias Same-Day Discharge after Non-Perforated Laparoscopic Appendectomy Is Safe Journal of Investigative Surgery appendicitis surgical site infection same day surgery outpatient ambulatory appendectomy |
| title | Same-Day Discharge after Non-Perforated Laparoscopic Appendectomy Is Safe |
| title_full | Same-Day Discharge after Non-Perforated Laparoscopic Appendectomy Is Safe |
| title_fullStr | Same-Day Discharge after Non-Perforated Laparoscopic Appendectomy Is Safe |
| title_full_unstemmed | Same-Day Discharge after Non-Perforated Laparoscopic Appendectomy Is Safe |
| title_short | Same-Day Discharge after Non-Perforated Laparoscopic Appendectomy Is Safe |
| title_sort | same day discharge after non perforated laparoscopic appendectomy is safe |
| topic | appendicitis surgical site infection same day surgery outpatient ambulatory appendectomy |
| url | http://dx.doi.org/10.1080/08941939.2019.1630065 |
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