Influence of discharge timing and diagnosis on outcomes of pediatric laparoscopic cholecystectomy.

Surgery 2017 12 16;162(6):1304-1313. Epub 2017 Oct 16.

Division of Pediatric Surgery, Women & Children's Hospital of Buffalo, Buffalo, NY; Department of Surgery, State University of New York at Buffalo, Buffalo, NY.

Background: This study evaluated the influence of discharge timing (same day versus other) on 30-day hospital readmissions after laparoscopic cholecystectomy in pediatric patients. Wound complication and readmission rates also were evaluated among patients with different operative indications.

Methods: The database of the National Surgical Quality Improvement Program-Pediatric (2012-2015) was queried for patients <18 years old who underwent laparoscopic cholecystectomy. Patient and operative variables as well as timing of discharge were assessed. Same-day discharge was defined as zero days between operation and discharge and was compared with patients discharged on the first or second postoperative day. Primary outcome was hospital readmission within 30 days; secondary outcomes included surgical site infections and wound complications.

Results: From 2012-2015, 5,046 patients underwent cholecystectomy (75.0% female; median age 13.7 years). Postoperative diagnoses included cholelithiasis (69.6%), cholecystitis (16.3%), biliary dyskinesia (12.3%), and pancreatitis (1.8%); all other diagnoses were excluded from analysis. Same-day discharge occurred in 1,061 patients (21.0%). Overall rate of readmission was 3.6% (3.9% among patients discharged on postoperative day 1 or 2 and 2.1% for patients discharged on the same day as the operation, P = .003). When compared according American Society of Anesthesiologists classification, patients of class 3 and class 4 were associated with increased odds of 30-day hospital readmission when compared with class 1 (odds ratio 2.27, 95% confidence interval 1.32-3.89, P = .003 and odds ratio 7.62, 95% confidence interval 1.47-39.70, P = .02, respectively). Similarly, patients with hematologic comorbidities compared with those without comorbidities also had increased odds of 30-day readmission (odds ratio 1.88, 95% confidence interval, 1.19-2.96, P = .007). Same-day discharge was not associated with increased readmission (odds ratio 0.60, 95% confidence interval, 0.38-0.94, P = .03) when compared with later discharge. Reasons for readmission did not differ between the same-day and later discharge groups. None of the demographic or clinical characteristics, including discharge timing, indication or operation, and preoperative duration of stay, were associated with increased odds of wound complications.

Conclusion: In pediatric patients undergoing laparoscopic cholecystectomy, same-day discharge is not associated with increased 30-day hospital readmission rates or wound complications when compared to discharge in 1 or 2 days. Same-day discharge seems safe and may be an applicable quality indicator for pediatric patients undergoing laparoscopic cholecystectomy.

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http://dx.doi.org/10.1016/j.surg.2017.07.029DOI Listing
December 2017
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