PACU discharge: equally safe and more cost-effective than floor admission for uncomplicated laparoscopic appendectomy.

Abstract

Background: Laparoscopic appendectomy is a common emergency surgical procedure worldwide, known for its benefits of reduced pain, shorter hospital stays, and quicker recovery times. Although postoperative care typically involves observation on the surgical floor, advances in surgical techniques and perioperative care have introduced the potential for discharging patients directly from the post-anesthesia care unit (PACU). This study aims to evaluate the safety and cost-effectiveness of direct PACU discharge compared to traditional floor admission for patients undergoing uncomplicated laparoscopic appendectomy.

Methods: This retrospective cohort study analyzed adult patients diagnosed with uncomplicated appendicitis between January 2021 and December 2023. Patients were divided into two cohorts: those discharged directly from PACU and those admitted to the floor before discharge. Primary outcomes included 30-day readmission rates, reoperation rates, and postoperative complications. Secondary outcomes assessed costs, surgery times, and demographic variables. Statistical analysis involved Pearson's chi-square tests, t-tests, and multivariate logistic regression.

Results: A total of 203 patients were included, with 103 in the PACU cohort and 100 in the floor cohort. PACU patients were younger and had fewer comorbidities than floor patients. No significant differences were found in 30-day readmission, reoperation rates, or complications between the groups. PACU discharge was associated with significantly shorter hospital stays (8 h vs. 26 h, p < 0.001) and lower costs, with average charges of $27,739 for PACU discharges versus $31,593 for floor discharges, primarily due to reduced labor costs.

Conclusion: Direct discharge from the PACU following uncomplicated laparoscopic appendectomy is both safe and cost-effective compared to floor admission. These findings suggest that PACU discharge is a viable option for well-selected patients, with the potential for significant healthcare savings. Future research should focus on refining patient selection criteria and validating these findings in diverse healthcare settings.