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Safety and Efficacy of Same-Day Discharge After Laparoscopic Appendicectomy: An Australian First Prospective Cohort
Prithvi Santana1, Odette Pheiffer1, Wing Yin Lau1
1Department of General Surgery, Campbelltown Hospital, Campbelltown, New South Wales, Australia.
Insights
Same-day discharge (SDD) after laparoscopic appendicectomy (LA) is safe and feasible in Australia. Careful patient selection and perioperative optimization are key to successful SDD protocols for appendicectomy.
Area of Science:
- Surgical outcomes
- Healthcare management
- Patient safety
Background:
- Same-day discharge (SDD) following laparoscopic appendicectomy (LA) is recognized globally for its safety and cost-effectiveness.
- Routine implementation of SDD for LA in Australia is limited, necessitating local evaluation.
Purpose of the Study:
- To assess the safety and feasibility of an SDD protocol for laparoscopic appendicectomy in an Australian hospital.
- To evaluate the outcomes, including re-presentation and readmission rates, associated with the SDD protocol.
Main Methods:
- A prospective quality control study was conducted at Campbelltown Hospital.
- The study evaluated the proportion of successful SDD for LA and day-case appendicectomy (DCA).
- 30-day re-presentation and readmission rates were key safety metrics.
Main Results:
- Of 82 patients meeting inclusion criteria, 70.7% achieved successful SDD, and 81.7% underwent day-case appendicectomy.
- Later operation start times and postoperative complications (Clavien-Dindo Grade I/II) predicted SDD failure.
- Low 30-day re-presentation (6.1%) and readmission (1.2%) rates were observed, with high patient satisfaction (83%).
Conclusions:
- SDD following LA is a safe and feasible option within the Australian healthcare system.
- Factors influencing SDD failure include operation timing and postoperative complications, emphasizing patient selection.
- The findings support the wider adoption of SDD protocols for LA with appropriate perioperative management.
Background:
Same-day discharge (SDD) following laparoscopic appendicectomy (LA) is internationally recognised as safe and cost-efficient, but its routine implementation in Australia remains limited. This study aimed to evaluate the safety, feasibility, and outcomes of an SDD protocol for LA within an Australian healthcare context.
Methods:
A prospective quality control study was conducted at Campbelltown Hospital from 1 August 2024 to 1 September 2025, following the introduction of an SDD protocol. We aimed to assess the feasibility and safety of SDD, measured by the proportion of successful SDD LA and day-case appendicectomy (DCA), and 30-day re-presentation and readmission rates, respectively.
Results:
Of 336 appendicectomies performed during the study period, 180 patients were considered for the SDD pathway and 82 met inclusion criteria. Successful SDD was achieved in 70.7% (n = 58), and DCA in 81.7% (n = 67). Multivariable analysis identified later operation start time (OR 1.93 per hour delay, p < 0.001) and postoperative Clavien-Dindo (CDC) Grade I (OR 32.9, p < 0.001) and Grade II complications (OR 26.5, p < 0.001) as independent predictors of SDD failure. 6.1% (n = 5) re-presented in 30 days, and one (1.2%) was readmitted. Patient experience was favourable: overall satisfaction was 83% among respondents (65%), and 70% preferred SDD.
Conclusion:
SDD following LA is safe and feasible in the Australian setting. Pathway failure was primarily driven by later operation timing and postoperative complications, highlighting the importance of careful patient selection and perioperative optimisation.
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