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 “The results are not surprising and rather reaffirm the practice
that patients may be discharged on the same day as the surgery if
the treating team feels it is appropriate,” said senior author Dr.
Armen Aboulian of Kaiser Permanente Woodland Hills Medical Center in
California.
“The decision for a patient to be discharged is based on numerous
things and many teams, including the operating surgeon, the
anesthesiologist, the recovery room team and any other consultants
that may have been involved,” Aboulian said. “It is a complex
decision but with this study, we showed that if patients are
discharged without spending the night, they do well and do not end
up returning to the emergency room at higher rates.”
The researchers studied more than 12,000 patients from Kaiser
Permanente medical centers in Southern California with acute
appendicitis who underwent laparoscopic – sometimes called “keyhole
surgery” - appendix removal between 2010 and 2014.
Roughly half of the patients were discharged from the hospital on
the same day and half were hospitalized overnight. About 2 percent
of those discharged on the same day were readmitted to the hospital
within 30 days, compared to 3 percent of the overnight group.
Complications like wound infection and postoperative visits to the
emergency treatment or diagnostic imaging studies were equally
common in both groups. Wound infection happened in 2.2 percent of
the group that went home and 2.7 percent of the hospitalized group,
for example. Imaging was done on 11 percent of the group that went
home and 12.3 percent of those who stayed overnight.
The patients who stayed overnight after their surgery were a bit
older, on average, and slightly more likely to have diabetes or high
blood pressure, the authors note.
The biggest difference between groups was in hospital costs. Those
discharged on the same day had an average cost of $1,994 compared to
$2,343 for overnight stays, as reported in the Journal of the
American College of Surgeons.
According to recent published studies, usual hospital stays after
laparoscopic appendectomy can be more than two or three days, and
same-day discharge may not be widely accepted yet, said Dr. Jae Gil
Lee of Yonsei University College of Medicine in Seoul, South Korea,
who was not part of the new study.
Countries where medical fees are not so high as the U.S. may feel
less pressure to reduce hospital stays, Lee told Reuters Health by
email.
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“Currently in the Southern California Kaiser Permanente Medical
System, approximately 60 percent of patients with non-perforated
appendicitis leave the hospital on the same day as the surgery,”
Aboulian told Reuters Health by email. “However, this is not the
traditional approach and even through the time period of our study,
there has been an annual increase in the tendency to discharge on
the day of the surgery.”
“These changes are part of the art of medicine and continued
education that is engrained in the American medical system,” he
said.
It’s hard to say if and why earlier hospital discharge leads to
better outcomes, other than reduced healthcare expenses, he said.
“For example, getting a good night sleep in your own bed without the
disturbance of the IV beeping or the 5 AM vitals check is difficult
to obtain as a measurable metric,” Aboulian said. “However, previous
studies have shown that an earlier discharge does correlate to a
faster recovery and an earlier return to normal activities such as
work.”
Surgeons may offer same-day hospital discharge, but patients and
family should not request it, he said.
“Patients usually are willing to stay (longer) at hospital, wanting
to feel less pain and to be controlled during the hospitalization,”
Lee said.
Older people and people with many additional medical conditions are
most often hospitalized for longer periods, Lee added.
SOURCE: http://bit.ly/2fSFD7J Journal of the American College of
Surgeons, online November 16, 2016.
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