Same-Day Discharge after Non-Perforated Laparoscopic Appendectomy Is Safe

Abstract

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.

Keywords:

• appendicitis
• surgical site infection
• same day surgery
• outpatient
• ambulatory
• appendectomy

COMPLIANCE WITH ETHICAL STANDARDS

This research involved humans. However, since this retrospective study was performed using a national database with deidentified patients, risk to participants is minimal. There is no consent required.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

REQUIRED STATEMENT FROM AMERICAN COLLEGE OF SURGEONS FOR ALL RESEARCHERS USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM

American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Additional information

Notes on contributors

Areg Grigorian

AG participated in study design, literature search, data collection, data analysis, data interpretation, statistical analysis, writing of first draft and critical revisions. CK participated in literature search, data analysis and critical revisions. SS, NN, CD, DK, ML participated in data analysis, data interpretation and critical revisions. JN participated in study design, literature search, data collection, data analysis, data interpretation and critical revisions. All authors approve of the final version of the manuscript submitted.

Catherine M. Kuza

AG participated in study design, literature search, data collection, data analysis, data interpretation, statistical analysis, writing of first draft and critical revisions. CK participated in literature search, data analysis and critical revisions. SS, NN, CD, DK, ML participated in data analysis, data interpretation and critical revisions. JN participated in study design, literature search, data collection, data analysis, data interpretation and critical revisions. All authors approve of the final version of the manuscript submitted.

Sebastian D. Schubl

AG participated in study design, literature search, data collection, data analysis, data interpretation, statistical analysis, writing of first draft and critical revisions. CK participated in literature search, data analysis and critical revisions. SS, NN, CD, DK, ML participated in data analysis, data interpretation and critical revisions. JN participated in study design, literature search, data collection, data analysis, data interpretation and critical revisions. All authors approve of the final version of the manuscript submitted.

Ninh T. Nguyen

AG participated in study design, literature search, data collection, data analysis, data interpretation, statistical analysis, writing of first draft and critical revisions. CK participated in literature search, data analysis and critical revisions. SS, NN, CD, DK, ML participated in data analysis, data interpretation and critical revisions. JN participated in study design, literature search, data collection, data analysis, data interpretation and critical revisions. All authors approve of the final version of the manuscript submitted.

Christian de Virgilio

AG participated in study design, literature search, data collection, data analysis, data interpretation, statistical analysis, writing of first draft and critical revisions. CK participated in literature search, data analysis and critical revisions. SS, NN, CD, DK, ML participated in data analysis, data interpretation and critical revisions. JN participated in study design, literature search, data collection, data analysis, data interpretation and critical revisions. All authors approve of the final version of the manuscript submitted.

Dennis Kim

AG participated in study design, literature search, data collection, data analysis, data interpretation, statistical analysis, writing of first draft and critical revisions. CK participated in literature search, data analysis and critical revisions. SS, NN, CD, DK, ML participated in data analysis, data interpretation and critical revisions. JN participated in study design, literature search, data collection, data analysis, data interpretation and critical revisions. All authors approve of the final version of the manuscript submitted.

Michael Lekawa

AG participated in study design, literature search, data collection, data analysis, data interpretation, statistical analysis, writing of first draft and critical revisions. CK participated in literature search, data analysis and critical revisions. SS, NN, CD, DK, ML participated in data analysis, data interpretation and critical revisions. JN participated in study design, literature search, data collection, data analysis, data interpretation and critical revisions. All authors approve of the final version of the manuscript submitted.

Jeffry Nahmias

AG participated in study design, literature search, data collection, data analysis, data interpretation, statistical analysis, writing of first draft and critical revisions. CK participated in literature search, data analysis and critical revisions. SS, NN, CD, DK, ML participated in data analysis, data interpretation and critical revisions. JN participated in study design, literature search, data collection, data analysis, data interpretation and critical revisions. All authors approve of the final version of the manuscript submitted.