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Published on: February 28, 2025
Assessing the value of overnight admission after pediatric laparoscopic cholecystectomy: A nationwide
Arsalan Javid1, Amna Minhas1, Humza Thobani2
1Loma Linda University Health, Department of General Surgery, Division of Pediatric Surgery, Loma Linda, CA, USA.
Insights
Same-day discharge after pediatric laparoscopic cholecystectomy (LC) is safe and efficient. This approach reduces unplanned readmissions and reinterventions compared to overnight stays, supporting resource stewardship.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Surgical Quality Improvement
Background:
- Optimizing postoperative care is crucial given healthcare resource constraints.
- Laparoscopic cholecystectomy (LC) is a common pediatric procedure with variable discharge practices.
- The benefit of overnight admission versus same-day discharge for pediatric LC is unclear.
Purpose of the Study:
- To compare the safety and resource utilization of same-day versus overnight discharge after pediatric LC.
- To evaluate the impact of discharge timing on unplanned readmissions, reinterventions, and postoperative complications.
Main Methods:
- Retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2017-2023).
- Children (<18 years) undergoing LC were analyzed.
- Propensity score matching (1:1) was used to balance patient and operative characteristics between same-day and overnight discharge groups.
Main Results:
- Same-day discharge was associated with significantly lower odds of 30-day unplanned readmission (aOR 0.56) and reintervention (aOR 0.16).
- Absolute readmission rates were 2.7% for same-day discharge vs. 4.7% for overnight (p=0.002).
- Opioid prescription at discharge was linked to increased readmission risk in exploratory analysis.
Conclusions:
- Same-day discharge after pediatric LC is a safe, common, and resource-efficient practice.
- Overnight admission offers minimal safety benefit and consumes valuable inpatient resources.
- Standardized same-day discharge pathways can enhance responsible resource stewardship in pediatric surgical care.
Introduction:
In an era of constrained healthcare resources, optimizing postoperative care without compromising safety has become a national priority. Laparoscopic cholecystectomy (LC) is among the most common pediatric procedures, yet discharge practices vary widely. Whether overnight admission offers meaningful benefit over same-day discharge remains uncertain.
Methods:
Children (<18 years) undergoing LC from 2017 to 2023 were identified in the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) participant use file. Patients were classified by discharge timing (same-day vs overnight). Propensity score matching (1:1) balanced demographic, clinical, and operative factors. The primary outcome was 30-day unplanned readmission; secondary outcomes included reintervention and postoperative complications.
Results:
Among 15,809 patients, 11,969 (76 %) were discharged the same day. After matching (n = 1725/group), same-day discharge was associated with lower odds of unplanned readmission (aOR 0.56, 95 % CI 0.38-0.80) and reintervention (aOR 0.16, 95 % CI 0.05-0.41). Absolute event rates were lower for readmissions (2.7 % vs 4.7 %, p = 0.002) and reinterventions (0.2 % vs 1.4 %, p < 0.001) in the same-day group. Notably, 96 % of readmissions occurred after 24 h and were for transient postoperative concerns unlikely to be prevented by inpatient observation. In an exploratory analysis of 2023 cases, opioid prescription at discharge was independently associated with increased readmission risk (aOR 1.97, 95 % CI 1.00-3.78).
Conclusion:
Same-day discharge after pediatric LC is common, safe, and resource-efficient. Overnight admission adds minimal safety benefit while consuming limited inpatient capacity. These findings support broader adoption of standardized same-day discharge pathways to promote responsible resource stewardship in pediatric surgical care.
Type Of Study:
Retrospective Cohort Study.
Level Of Evidence:
III.
