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Same-day discharge after appendectomy for uncomplicated appendicitis in children: Potential barriers to increased

Radek Buss1, Catherine A Bodnar1, Kimberly K Somers1

  • 1Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.

American Journal of Surgery
|April 13, 2022
PubMed

Insights

Same-day discharge (SDD) after appendectomy for uncomplicated appendicitis is less common when surgery occurs later in the day or for patients facing socioeconomic or travel barriers. Optimizing operative timing and addressing these factors can increase SDD utilization.

Area of Science:

  • Pediatric Surgery
  • Health Services Research

Background:

  • Same-day discharge (SDD) after appendectomy for uncomplicated appendicitis (UA) offers potential benefits but faces barriers to widespread adoption.
  • Understanding these barriers is crucial for optimizing patient care pathways.

Purpose of the Study:

  • To investigate factors influencing the utilization of same-day discharge (SDD) following appendectomy for uncomplicated appendicitis in children.
  • To identify potential barriers hindering increased SDD rates.

Main Methods:

  • A retrospective review of 973 children (≤18 years) who underwent appendectomy for UA between 2015 and 2019 at a tertiary care children's hospital.
  • Multivariable regression models were employed to assess associations with SDD utilization.

Main Results:

  • SDD was significantly less frequent for surgeries performed between 12 PM and 5 PM (aOR 0.14) and after 5 PM (aOR 0.01) compared to before 12 PM.
  • Lower socioeconomic status (higher Area Deprivation Index), female gender (aOR 0.53), and longer travel times (30-60 min, aOR 0.56) were associated with reduced SDD utilization.

Conclusions:

  • Operative timing, socioeconomic factors, and patient travel distance are primary determinants of SDD utilization after pediatric appendectomy.
  • Targeted quality improvement initiatives focusing on these factors are recommended to enhance SDD rates.
Abstract

Keywords:
AppendicitisChildrenOutcomesValue

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