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Same day discharge after laparoscopic cholecystectomy in children
Brian G A Dalton1, Katherine W Gonzalez1, Erol Marty Knott1
1Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri.
Insights
Same day discharge (SDD) after laparoscopic cholecystectomy (LC) for gallstones and biliary dyskinesia is safe in children. This approach reduces hospital stays without increasing complications, with staff comfort improving over time.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Limited data exist on same day discharge (SDD) safety for pediatric laparoscopic cholecystectomy (LC).
- Adult data support SDD for symptomatic cholelithiasis (SC) and biliary dyskinesia (BD).
Purpose of the Study:
- To analyze the initial experience with a new SDD protocol for pediatric LC.
- To evaluate the safety and efficacy of SDD in children undergoing LC for SC and BD.
Main Methods:
- Retrospective chart review of 227 pediatric LC cases from January 2011 to July 2014.
- Comparison of outcomes between the SDD group (n=57) and overnight stay (ONS) group (n=170).
Main Results:
- No significant differences in complication rates or readmissions between SDD and ONS groups.
- SDD group had a significantly shorter length of stay.
- Obstacles to SDD included late surgery times and clinical habits, which improved with protocol experience.
Conclusions:
- SDD is a safe option for pediatric patients undergoing LC for SC or BD.
- Addressing surgical timing and clinical practices can increase SDD rates.
Background:
Although the safety of same day discharge (SDD) after laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis (SC) and biliary dyskinesia (BD) in adults has been well documented in the literature, the same data in the pediatric population are lacking. We have recently instituted a protocol for SDD after LC for SC and BD, and this study is an analysis of our initial experience.
Methods:
A retrospective chart review of all patients who underwent LC for BD and SC in our institution from January 2011-July 2014 was performed.
Results:
A total of 227 LC were performed for SC and BD during the study period. Approximately 25% (n = 57) of patients were in the SDD group. The remaining 75% (n = 170) of patients were admitted at least overnight stay (ONS) for the following reasons: medical 16.5% (n = 28), surgery ending too late 4.1% (n = 7), or clinical care habits 79.4% (n = 135). Comparing the SDD group with ONS group, no differences were found in the complication rate, readmissions, or follow up before scheduled appointment. Length of stay was significantly less for the SDD group than for the ONS. A trend for more SDDs was observed as time elapsed from initiation of the protocol. Also, earlier completion of surgery trended toward SDD.
Conclusions:
SDD appears safe for pediatric patients undergoing LC for BD or SC. The main obstacles to discharge were time of surgery completion and clinical care habits, both of which improved as comfort level with SDD grew among the staff.
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