Laparoscopic versus open abdominal surgery in children with sickle cell disease is associated with a shorter hospital stay

Abstract

For children with SCD who need a cholecystectomy or splenectomy, laparoscopy is the preferred strategy because of a shorter hospital stay with a similar complication rate compared to open surgeries.

Splenectomy reduces packed red cell transfusion requirement in children with sickle cell disease

“…The mean length of postoperative stay in the current series for laparoscopic procedures was 3 days, which is similar to that reported in the literature [21,22]. Laparoscopic splenectomy has been shown to confer a clear benefit of shorter hospital stay when compared to open splenectomy in sickle cell children [22].…”

“…Laparoscopic splenectomy has been shown to confer a clear benefit of shorter hospital stay when compared to open splenectomy in sickle cell children [22]. The rate of acute chest syndrome in the current series (6%) is toward the lower end of the published rates of acute chest syndrome after abdominal surgery (5%-15%) [21,22].…”

Abdominal Pain in Children With Sickle Cell Disease

“…Scheduled cholecystectomy is typically laparoscopic rather than open, which has been shown to reduce the length of hospitalization without increasing intraoperative risks. 16 Therapeutic management of children with SCD incidentally found to have cholelithiasis by ultrasound for another reason, but who are asymptomatic, remains unclear. Some advocate cholecystectomy before complications, 17 but others would wait, as complications from asymptomatic cholelithiasis are rare.…”

Fifty ways to reduce length of stay: An inventory of how hospital staff would reduce the length of stay in their hospital

“…And in addition treating patients in a joint care programme [42,43] • Surgical pre-assessment, planning the admission, post-operative care and planning a safe discharge [44], early imaging with CT, MRI, or nuclear scintigraphy, particularly on the day before or the day of admission [45] • Preventing admissions of patients not needing inpatient care [46][47][48] • Utilising specialised nurse practitioners or other advanced professionals [49][50][51] • Creating an observation unit that gives more time to decide whether or not to admit the patient [52] • Stimulating that patients initially are seen by the right specialty [53] • Performing same-day major surgery [47] • Optimising guidelines and protocols or introducing clinical pathways for specific patient groups in order to reduce the length of stay and often with improvements of quality of care • Treating patients in a fast-track or accelerated care programme [54][55][56][57][58][59][60][61][62] • Choosing a laparoscopic rather than a classic intervention (open surgery) [63][64][65][66][67][68][69][70] although readmission rates for laparoscopic treatment may be higher [71] • Implementing an acute stroke unit [72] • Being aware that consultations, transfers and fragmentation of care often lead to delays [73,74] • Reducing waiting times for examinations [8,48] • Stimulating early rehabilitation and physical activity [75]…”