An analysis of set time, outcome indicators, and medicines of pediatric patients undergoing laparoscopic appendectomy
Chung, Eric Robert
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INTRODUCTION: There currently exists a wide variation in anesthesia perioperative management for pediatric patients undergoing laparoscopic appendectomy. The purpose of this retrospective chart review is to compare outcome indicators by using patient demographics. This study aims to establish evidence based guidelines for safe, efficient and effective anesthetic management for patients undergoing laparoscopic appendectomies by analyzing selected outcome indicators and metrics in relation to Surgical-End-to-Transport (SET) time: defined as the time from the end of surgical time until the patient is ready to exit the operating room. METHODS: After institutional review board approval, all laparoscopic appendectomies performed from 2012 through 2014 (n=790) were queried. Using the median SET time of 14 minutes, two groups were established as follows: Group A (n=431), SET time between 0 and 14 minutes, and Group B (n=338), SET time of 14 minutes and longer. Bivariate and multivariate logistic regression models were used to compare readmissions by American Society of Anesthesiologists (ASA) status and reports of high pain with PACU (Post-Anesthesia Care Unit) duration, gender, age, and surgical duration using IBM SPSS Statistics (version 21.0, IBM, Armonk, NY). RESULTS: To limit confounding variables, patients over the age of 21 and those assigned an ASA Physical Status Classification 3 or 4 were excluded. Remaining cases (n=769) were then used to calculate readmission incidence. The median SET time for the study population was 14 minutes, while the median surgical and PACU durations were 58 minutes and 59 minutes, respectively. The readmission incidence rate was 300 per 10,000 (n=23, 3%). The study population consisted of 56% males and 44% females. Females had a higher incidence of readmission (n=13, 3.8%) than males (n=10, 2.3%), while males had longer SET times than females (Group A Males 52.33% vs. Group B Males 60.30%, p=0.0276). There was no difference in readmission incidence rates between ASA I (n=473) and ASA II (n=296) patients (ASA I readmits 3.2 % vs. ASA II readmits 2.7%, p=.711). Patients who reported high postoperative pain (n=75) were more than twice as likely to be readmitted than patients who did not report high pain (p=.071). Ethnicity frequencies were collected as follows: 60.3% White, 6.8% Black or African American, 3.6% Asian, and 29.1% Other. DISCUSSION: Males had significantly longer durations in SET times, and they experienced fewer readmissions than females. There were no significant findings related to the ethnic demographics. Further analysis identifying intraoperative and postoperative anesthesia management for both groups will be performed. This study was subject to the following limitations: retrospective design, incomplete data acquisition, and inconsistent EMR documentation. The correlations and results are preliminary in nature and will serve as a framework for future analyses.