- November 25, 2016
- Posted by: emobile
- Category: Researcher's Corner
Emobileclinic Researchers Corner
The American College of Surgeon Journal has published an online version of the findings of researchers who discovered that the risk of postoperative complications is lower in patients who undergone laparoscopic appendectomy and were discharged same day compare to those who passed the night in the hospital. The journal is yet to be printed for public consumption.
The prevalence of acute appendicitis in the United States is high as over 250,000 appendectomies are done in the United States. Interestingly, more of these patients are discharged home from the recovery room, preventing hospital admission.
Dr Armen Aboulian, a principal author of the study notes that “advances in early recognition and treatment of the disease process and minimally invasive techniques have allowed for some of the inflammatory response and the trauma from surgical treatment to be lessened and recovery to be faster; as a result, patients can get back to their lives much sooner” and added that “now up to 60 percent of non-perforated acute appendicitis patients at Kaiser Permanente are treated without an overnight stay”.
After the procedure, the decision to either discharges the patient or admits the patient is solely made by the medical doctor. The concern has remained as to whether patients with a same-day discharge are more likely to return with complications and be readmitted.
It was against this background that the researchers conducted a detailed evaluation of the medical records of 12,703 patients who had laparoscopic appendectomy for non-perforated appendicitis at 14 Southern California Region Kaiser Permanente medical centers from 2010 to 2014. The participants comprised of 6,710 patients who were discharged on the same day of their procedure and 5,993 patients who were hospitalized overnight.
The Procedural and Anesthesia Scoring System is used for all patients who are discharged home from the recovery room after any operation in all Southern California Kaiser Permanente Medical Centers. The basis for discharge is for the patients to have a score above 12; those with a score of 12 or less remain in the hospital at the same level of care.
The team compared the patients discharged on the day of an operation with those hospitalized overnight. The result showed that the group discharged on the same day of an operation had almost the same return rates to emergency rooms or urgent care centers and an overall lower rate of readmission within 30 days when compared with those who were hospitalized overnight.
For the two groups, postoperative rates of returns to the emergency room or radiology department for diagnostic or therapeutic imaging studies were statistically the same. Postoperative general surgery department visits recorded slightly higher in the hospitalized group.
Dr Aboulian further remarked that “in general, recovery at home is preferred by most patients and sleeping in your own bed has benefits that are difficult to measure,” and “at the same time, the goal of the study is not to rush the patients home, but rather, the importance of this study lies in the confirmation that discharge from the recovery room is safe and surgeons across the nation may consider it directly from the recovery room in the appropriate setting.”
More importantly, the study revealed that same day discharge results in an average direct cost savings of $348 per case within the Kaiser Permanente system. It also suggested that when patients are sent home from the recovery room without an overnight stay, they would be saving $921,500,000 annually on health care in the United States.
Dr Aboulian also said that “this study is significant because it demonstrates that patients may be treated safely with surgery and discharged on the same day as the operation”. He recalled that “two hundred years ago, the diagnosis of appendicitis had more than a 60 percent mortality rate. Now these patients are treated and don’t even have to spend the night in the hospital. Medical treatment for this disorder has come a long way.”
Armen Aboulian et.al (2016): Same-Day Discharge in Laparoscopic Acute Non-Perforated Appendectomy. Journal of the American College of Surgeons, doi: 10.1016/j.jamcollsurg.2016.10.026