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Variability in same-day discharge for pediatric appendicitis
Tolulope A Oyetunji1, Dani O Gonzalez2, Pablo Aguayo1
1Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
Insights
Same-day discharge (SDD) after appendectomy for nonperforated appendicitis is increasingly used in children. However, utilization varies significantly by ethnicity and hospital region, warranting further investigation.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Quality Improvement
Background:
- Same-day discharge (SDD) after appendectomy for nonperforated appendicitis shows feasibility and potential as a quality indicator.
- Earlier appendectomy post-admission offers greater opportunities for SDD.
- National data analysis is needed to understand SDD patterns and limitations in children.
Purpose of the Study:
- To assess the national utilization patterns of SDD in children undergoing appendectomy on the day of admission.
- To identify potential limitations and predictors of SDD in this pediatric population.
- To examine variations in SDD based on patient demographics and hospital characteristics.
Main Methods:
- Utilized the 2009 Kids Inpatient Database (KID) for children with acute appendicitis undergoing appendectomy.
- Excluded cases with perforated appendicitis or missing procedure codes.
- Analyzed length of stay (LOS), procedure type (laparoscopic vs. open), demographics, hospital designation, and region to determine predictors of SDD.
Main Results:
- Analysis included 56,077 weighted cases of nonperforated appendicitis.
- Laparoscopic appendectomy was associated with a 50% reduced likelihood of non-SDD compared to open procedures.
- Hispanic and African American children, and those in Midwest and Southern hospitals, showed higher rates of non-SDD.
Conclusions:
- SDD utilization for pediatric nonperforated appendicitis is growing but exhibits significant disparities.
- Variations in SDD rates across ethnicities and hospital regions require further investigation.
- Understanding these disparities is crucial for evaluating SDD as a quality-of-care indicator.
Background:
Recent single-institutional data point to the feasibility of same-day discharge (SDD) after appendectomy for nonperforated appendicitis and its potential as a quality-of-care indicator. Opportunities for SDD are greatest the sooner the appendectomy is performed after admission. We examine a national database to assess the pattern of SDD utilization among children who underwent appendectomy on the day of admission and potential limitations to SDD.
Methods:
The 2009 Kids Inpatient Database (KID) was queried for children with a diagnosis of acute appendicitis who had appendectomy. Exclusion criteria included those children with perforated appendicitis or those in whom the procedure code was missing. Day from admission to procedure day and total length of stay (LOS) were then analyzed by demographics, type of procedure (laparoscopic versus open), children's hospital designation, and hospital region. After stratifying all patients undergoing appendectomy on day of admission into two groups by LOS (≤1 d, SDD versus >1 d, non-SDD), a multivariate analysis was then performed to determine the predictors of SDD.
Results:
A total of 38,959 records, representing a weighted estimate of 56,077 patients with a diagnosis of nonperforated appendicitis, met the inclusion criteria. Median age was 14 y with interquartile range of 10-17 y. Median LOS was 1 d (interquartile range, 1-2 d), and the majority (71.8%) had laparoscopic appendectomy. On adjusted analysis, laparoscopic cases were 50% less likely to be non-SDD compared with their open counterparts (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.47-0.53). Compared with Caucasians, significantly more Hispanics (OR, 1.44; 95% CI, 1.36-1.56) and African Americans (OR, 1.57; 95% CI, 1.42-1.73) were non-SDD. Hospitals in the midwest and south were more likely to be non-SDD.
Conclusions:
SDD is increasingly used for children with nonperforated appendicitis, but there is significant variability in the utilization of SDD for different ethnicities and hospital regions. These variations need to be further investigated to better delineate its potential role as a quality-of-care indicator.
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