By Andrew M. Seaman
NEW YORK (Reuters Health) - Most children and teens getting their appendix removed could probably go home on the same day they have surgery without facing an increased risk of complications, a new study suggests.
Researchers at Miami Children's Hospital tested the theory on more than 200 pediatric appendectomy cases, and the kids who went home after surgery had about the same rates of complications and readmissions as the kids who stayed in the hospital overnight. Most parents didn't seem to mind the same-day discharge.
The researchers say the shortened hospital stay reduces the kids' stress related to being away from home, and it may cut the risk of a hospital-acquired infection as well as trimming costs -- possibly by thousands of dollars.
If it's possible, sending kids home the same day as their surgery "is a great trend," said Dr. Henry Rice, chief of pediatric general surgery at the Duke University Medical Center in Durham, North Carolina.
Rice, who was not part of the study, told Reuters Health that in some ways it's healthier for the children to be home in a familiar environment.
For the new study, researchers led by Dr. Cathy Burnweit followed all the kids between ages two and 19 who had their appendix removed at Miami Children's between July 2010 and April 2011.
Appendectomies are typically needed when the appendix becomes inflamed and painful, usually because of an infection. It is the most common emergency abdominal surgery performed in the U.S.
Of 251 kids and teens admitted for appendectomy, doctors considered 207 eligible to go home the same day as their surgery. Another 44 children had more severe problems that required longer hospitalization.
Most of the kids' appendixes were removed laparoscopically -- using a small scope inserted through the patients' bellybuttons.
Of the 207 kids eligible to go home, 162 did, and 45 were admitted to the hospital overnight because it was too late to be discharged, the family couldn't arrange transportation, they didn't want to be sent home the same day or they were vomiting or had pain.
Overall, no patient in the study experienced a major complication.
Two kids (4.4 percent) in the group that stayed in the hospital overnight were later seen in an emergency room before their scheduled follow-up visit, while 12 kids (7.4 percent) in the group that went home the same day as their surgery were seen in an ER. The researchers said this three-percent difference was not statistically significant, meaning it is so small it could have been due to chance.
Parents of 141 kids in the same-day discharge group (87 percent) said they were pleased with the quick hospital discharge. Another 13 parents (eight percent), however, said they were nervous but happy about taking their child home. Eight parents (five percent) said they didn't think it was best for their child to go home the same day.
When the parents were asked again how they felt two or three weeks later, only one said they would not choose to bring their child home the same day again.
According the researchers, same-day surgery not only benefits patients, it saves money and resources.
An appendectomy can cost several thousand dollars, but up to $2,000 can be knocked off the bill for every day not spent in the hospital, they note in their report, published in the Archives of Surgery.
"All these effects are laudable if patient safety can be maintained," they add.
The idea of same-day discharge after appendectomy is not entirely novel, according to Dr. Thane Blinman, a general surgeon at the Children's Hospital of Philadelphia in Pennsylvania who was not involved in the Miami research.
A lot of surgeons around the country send their kids out on the same day if they're ready to go, he said. What's new about this study is how many can go home. But the report "does not do a great job" of identifying which patients are the best candidates to be sent home the same day, he added.
Blinman told Reuters Health there are some people that should be kept overnight and he hopes insurance companies do not "take these results and run with it."
"The fear with a study like this is that people read this and say, 'well it's just fine to kick them out right after surgery,'" he explained.
Blinman said his hospital sometimes sends kids home on the same day as a surgery, and there are a few questions parents should ask if they're ever put in the position of taking their child home right after surgery.
"They should ask what they should do for pain. They should ask what they should do for nausea, and they should know absolutely who to call for trouble," he said.
SOURCE: http://bit.ly/KLcLFx Archives of Surgery, online May 21, 2012.