Same-day discharge after appendectomy for acute appendicitis: a systematic review and meta-analysis

Abstract

Purpose Patients presenting with acute appendicitis are usually hospitalized for a few days for appendectomy and postoperative recovery. Shortening length of stay may reduce costs and improve patient satisfaction. The purpose of this study was to assess the safety of same-day discharge after appendectomy for acute appendicitis. Methods A systematic review was performed according to PRISMA guidelines. A literature search of EMBASE, Ovid MEDLINE, Web of Science, Cochrane Central, and Google Scholar was conducted from inception to April 14, 2020. Two reviewers independently screened the literature and selected studies that addressed discharge on the same calendar day as the appendectomy. Risk of bias was assessed with the ROBINS-I tool. Main outcomes were hospital readmission, complications, and unplanned hospital visits in the postoperative course. A random effects model was used to pool risk ratios for the main outcomes. Results Of the 1912 articles screened, 17 comparative studies and 8 non-comparative studies met the inclusion criteria. Most only included laparoscopic procedure for uncomplicated appendicitis. Most studies were considered at moderate or serious risk of bias. In meta-analysis, same-day discharge (vs. overnight hospitalization) was not associated with increased rates of readmission, complication, and unplanned hospital visits. Non-comparative studies demonstrated low rates of readmission, complications, and unplanned hospital visits after same-day discharge. Conclusion This study suggests that same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis is safe without an increased risk of readmission, complications, or unplanned hospital visits. Hence, same-day discharge may be further encouraged in selected patients. Trial registration PROSPERO registration no. CRD42018115948

Feasibility of Same-Day Discharge After Appendectomy in Pediatric Patients: A Systematic Review and Meta-Analysis

“…It might be that same day discharge is possible because of this lower risk and those with wound infection/complication would have required additional management and/or observation, thereby necessitating stay at the hospital. These findings are in agreement with a previous review by Elisabeth et al ( 14 ) that looked at studies done in both adult and pediatric populations and indicated that same-day discharge after laparoscopic appendectomy in patients with uncomplicated appendicitis is relatively safe and is not associated with a higher risk of readmission, complications, or unplanned hospital visits. One of the major drawbacks of the earlier review was that it did not provide stratified findings based on adult and pediatric subjects.…”

“…Studies, in both adult and pediatric populations, have examined the possibility of the same-day discharge (SDD). A recent review was conducted to assess the safety of the same-day discharge after appendectomy in adults and children with acute appendicitis ( 14 ). The review included 17 studies and performed a comparative analysis between same-day discharge and non-same day discharge.…”

“…The majority of the studies included adult subjects. The review concluded that for the cases of uncomplicated appendicitis, SDD was safe and was not associated with an increased risk of readmission, unplanned visits to, the hospital, or complications ( 14 ). Recently, there has been a lot of interest in evaluating the safety of SDD in children and adolescents undergoing laparoscopic appendectomy for uncomplicated appendicitis.…”

Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis

“…Efforts to reduce LOS after laparoscopic appendectomy may relieve pressure on hospital bed capacity, decrease healthcare costs, and improve treatment satisfaction. Many studies have evaluated the safety and feasibility of early discharge after laparoscopic ap-pendectomy [7]. However, as with any surgical procedure, approximately 2% to 23% of laparoscopic appendectomy patients experience postoperative complications [8,9].…”

Hospitalization Trends for Acute Appendicitis in Spain, 1998 to 2017

“…A systematic review and meta-analysis from 2021 suggested that same-day discharge following laparoscopic appendectomy for uncomplicated appendicitis is safe and does not increase the risk of readmission, complications, or unplanned hospital visits. Moreover, it can reduce costs and improve the patient’s satisfaction [ 37 ].…”