Same-day discharge often safe after appendix surgery

Many patients who have their appendix removed can safely go home from the hospital the same day, according to a new study.

“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.

“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.