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Early discharge after appendicectomy in children
C E Velhote1, T F de Oliveira Velhote, M C Velhote
1Division of Pediatric Surgery, Children's Institute, Hospital da Santa Casa de Ribeirão Preto, São Paulo, Brazil.
Insights
Same-day discharge appendicectomy (day-care surgery) is safe for children. This approach reduces hospital stays and costs without increasing the risk of complications in pediatric appendicitis patients.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
Background:
- Appendicectomy is a common surgical procedure in children.
- Traditional hospital stays for pediatric appendicectomy can be lengthy and costly.
Purpose of the Study:
- To evaluate the safety and feasibility of same-day discharge appendicectomy (day-care surgery) in pediatric patients.
- To determine if day-care appendicectomy impacts complication rates or hospital costs.
Main Methods:
- A prospective study was conducted in pediatric hospitals in Brazil.
- 144 children underwent standard muscle-splitting appendicectomy.
- Key outcomes measured included hospital stay duration, antibiotic use, and complication rates.
Main Results:
- 86% of children (124 patients) were discharged within 24 hours of surgery.
- The overall infective complication rate was 8% (12 patients), comparable to larger appendicectomy series.
- Most patients received prophylactic metronidazole, with 54% receiving no postoperative antibiotics.
Conclusions:
- Same-day discharge appendicectomy is a safe and feasible option for children.
- This approach effectively reduces hospital stay duration and associated healthcare costs.
- Day-care appendicectomy does not appear to increase the risk of complications in pediatric patients.
Objective:
To confirm that "day-care" appendicectomy is safe in children.
Design:
Prospective study.
Settings:
Paediatric hospitals, Brazil.
Subjects:
144 children who required removal of the appendix.
Interventions:
Standard muscle splitting appendicectomy.
Main Outcome Measures:
Hospital stay, use of antibiotics, and complications.
Results:
124 patients (86%) were discharged within 24 hours of operation. In all patients the appendicitis was confirmed and grouped according to histopathological findings (72 inflamed, 26 gangrenous and 26 perforated). 86 patients (60%) were given metronidazole one hour before operation as prophylaxis against postoperative abscess formation. 78 (54%) were given no antibiotics in the postoperative period. 2 patients were readmitted for drainage of intraperitoneal abscesses and 10 had subcutaneous abscesses drained as outpatients during the early postoperative period. The overall infective complication rate was 8% (n = 12), which is comparable with large series of appendicectomy in children.
Conclusions:
"Day-care" appendicectomy is safe and feasible in children, as it avoids a long hospital stay and increased costs with no additional risk.