| Sažetak | Objectives: The aim of this study was to determine the safety and parental satisfaction of
discharge home within 24 hours after laparoscopic appendectomy for uncomplicated acute
appendicitis (AA).
Patients and Methods: From March 1st, 2021, to May 1st, 2022, a total of 180 patients were
included in the study. All patients, ages 6 to 17, who underwent laparoscopic appendectomy
for uncomplicated AA and were discharged to home care within 24 hours of the procedure,
performed by three pediatric surgeons, were included in this prospective non-randomized
cohort study. Demographic data, input characteristics, duration of surgery, intraoperative and
postoperative complications, treatment outcomes as well as parental satisfaction and pain
levels were recorded.
Results: The median age was 11 years (IQR 10, 14). Slightly male predominance 63.8% (n =
115) was recorded. The median postoperative hospital stay was 15 hours (IQR 12, 19). The
majority of parents (n = 155, 86.1%) expressed the highest satisfaction at the day of discharge,
while the remaining 25 (13.8%) expressed moderate satisfaction. Median pain levels
according to VAS for all postoperative days were low, counting: 4 (IQR 4, 6), 2 (IQR 2, 5), 2
(IQR 0, 4), 1 (IQR 0, 2), 0 (IQR 0, 2) and 0 (IQR 0, 0) for 1st, 2nd, 3rd, 4th, 5th, and 6th-7th
postoperative day, respectively. Four patients (2.2%) had an unplanned readmission to
hospital treatment before the 7th postoperative day because of postoperative abscess and were
treated conservatively. Almost all parents (n = 175, 97.2%) expressed the highest level of
satisfaction during the outpatient follow-up examination on day 7.
Conclusion: Discharge, for home care, within 24 hours after laparoscopic appendectomy due
to uncomplicated AA in children is safe and feasible, and parental satisfaction is high. With
the right algorithm and parent education, especially in the days of the COVID-19 pandemic,
uncomplicated AA may be treated in this way. |
| Sažetak (hrvatski) | Ciljevi: Cilj ovog istraživanja bio je utvrditi sigurnost i zadovoljstvo roditelja otpustom kući
unutar 24 sata nakon laparoskopske apendektomije zbog nekomplicirane akutne upale
crvuljka.
Materijali i metode: Od 1. ožujka 2021. do 1. svibnja 2022., u studiju uključeno je ukupno
180 bolesnika. Svi bolesnici, od 6 do 17 godina, kojima je učinjena laparoskopska
apendektomija, izvedena od strane tri dječja kirurga, zbog nekompliciranog AA, a koji su
otpušteni na kućnu njegu unutar 24 sata od zahvata, uključeni su u ovo prospektivno
nerandomizirano kohortno istraživanje. Demografski podatci, ulazne karakteristike, duljina
trajanja operacijskog zahvata, intraoperacijske i poslijeoperacijske komplikacije, ishodi
liječenja te zadovoljstvo roditelja i razina boli su zabilježene.
Rezultati: Medijan dobi iznosio je 11 godina (IQR 10, 14). Zabilježena je blaga
predominacija 63,8% (n=115) muškog spola. Medijan poslijeoperacijskog boravka u bolnici
iznosio je 15 sati (IQR 12, 19). Većina roditelja (n=155, 86,1%) iskazala je najviše
zadovoljstvo danom otpusta, dok je ostatak 25 (13,8%) iskazalo osrednje zadovoljstvo.
Medijani razine boli prema VAS-u za sve poslijeoperacijske dane bili su niski, brojeći: 4
(IQR 4, 6), 2 (IQR 2, 5), 2 (IQR 0, 4), 1 (IQR 0, 2), 0 (IQR 0, 2) i 0 (IQR 0, 0) za 1., 2., 3., 4.,
5. i 6.-7. poslijeoperacijski dan. Četiri bolesnika (2,2 %) su neplanirano ponovno primljena na
bolničko liječenje zbog poslijeoperacijskog apscesa, prije 7. poslijeoperacijskog dana te su
liječeni konzervativno. Gotovo svi roditelji (n=175, 97,2%) iskazali su najvišu razinu
zadovoljstva prilikom ambulantnog kontrolnog pregleda (7. dan).
Zaključci: Otpust, na kućnu njegu, unutar 24 sata nakon laparoskopske apendektomije zbog
nekompliciranog AA u djece je siguran i izvediv, a zadovoljstvo roditelja je visoko. Uz
odgovarajući algoritam i edukaciju roditelja, posebno u vrijeme pandemije COVID-19,
preporuča se otpust unutar 24 sata za djecu s nekompliciranim apendicitisom. |
