Risk Factors for Readmission After Short-Hospital-Stay Laparoscopic Appendectomy

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ORIGINAL SCIENTIFIC REPORT

Risk Factors for Readmission After Short-Hospital-Stay Laparoscopic Appendectomy Cristian A. Angeramo1 Francisco Schlottmann1



Nicolas H. Dreifuss1 • Ayelen A. Olivero1 • Emmanuel E. Sadava1



Accepted: 1 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020

Abstract Background Single-day discharge is a common practice among patients undergoing laparoscopic appendectomy (LA). We aimed to determine risk factors associated with readmission in patients with short hospital stay after LA. Methods We performed a retrospective analysis of all patients who underwent LA during the period 2006–2019. Patients with length of hospital stay shorter than 24 h were included. Demographics, operative variables, and postoperative outcomes were analyzed. Multivariable logistic regression was performed to determine risk factors for readmission. Results A total of 2009 LA were performed during the study period; 1506 (75%) patients had short hospital stay and were included in the analysis. Median age was 31 (14–85) years, and 720 (48%) were female. Mild peritonitis was diagnosed in 423 (28%) patients, and 121 (8%) had gangrenous/perforated appendicitis. Mean surgical time was 51(14–180) min. Conversion rate was 0.4%. There were 143 (9%) postoperative complications, including 29 (1.9%) patients with postoperative intra-abdominal abscess. Nine patients (0.6%) underwent reoperation, and only 26 (1.7%) patients were readmitted. The mean time to hospital readmission was 6 (1–14) days. Although age [50 years, obesity, mild peritonitis, and complicated appendicitis were more frequent among patients readmitted, only age [50 years (OR 3.54 95% CI 1.51–8.30) and mild peritonitis (OR 6.16 95% CI 1.80–34.93) were found as independent risk factors for readmission. Conclusion Most patients undergoing LA can be safely discharged within 24 h of admission. Patients over 50 years old and/or with localized peritonitis have significantly higher risk of readmission and therefore may need a closer postoperative follow-up.

Introduction Acute appendicitis is the most common indication for emergency surgery, with an estimated incidence of 100 per 100,000 persons-year in the USA [1]. Despite that medical treatment with antibiotics alone has been proposed as & Cristian A. Angeramo [email protected] 1

Department of Surgery, Hospital Alema´n of Buenos Aires, 1640 Pueyrredon Ave, Capital Federal, Buenos Aires, Argentina

curative treatment, laparoscopic appendicectomy (LA) still represents the gold standard treatment [2]. Currently, length of hospital stay (LOS) after gastrointestinal surgery tends to decrease due to the use of minimally invasive techniques and enhanced recovery protocols after surgery [3]. Moreover, as LA is commonly performed in young and healthy individuals and has low postoperative morbidity [4], several reports have shown the safety and feasibility of short hospital stay (\24 h) or ambulatory (same working-day) LA [3–9]. A short hospital stay after LA has the potential of reducing healthcare expe