Impact of a 24-hour discharge pathway on outcomes of pediatric appendectomy

Putnam, Luke R.; Levy, Shauna; Johnson, Elizabeth; Williams, Karen; Taylor, Kimberlee; Kao, Lillian S.; Lally, Kevin P.; Tsao, KuoJen

doi:10.1016/j.surg.2014.03.030

Cited by 40 publications

(51 citation statements)

References 23 publications

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“…pLOS in these cohorts is more often reported in hours rather than days; Halter et al and Alkhoury et al reported the shortest mean pLOS, being 2.5 (±1.26, range 1–5.5) hours and 4.8 (±2.1, range 1–12) hours respectively . Same‐day discharge was reported to have increased over three‐fold after introduction of an expedited care pathway from 12% to 42% of admissions in one study while Putnam et al reported an even more dramatic increase in same‐day discharge rates from 13% to 58% …”

Section: Resultsmentioning

confidence: 92%

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Do‐Wyeld

Rogerson

Court‐Kowalski

et al. 2019

ANZ Journal of Surgery

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Background ‘Fast‐track’ surgery protocols aim to standardize and rationalize post‐operative care, with evidence of safety and efficacy in both uncomplicated and complicated childhood appendicitis. Generalization for broader adoption has been limited by variation in protocol design, including specific antibiotic choice, discharge criteria, post‐operative monitoring and patient selection. Methods A systematic review of the literature was performed to evaluate the current evidence underpinning fast‐track protocols for childhood appendicitis and identify areas of consensus and controversy. Results About 33 studies met the inclusion criteria, including four prospective observational studies, 20 case–control studies, seven cohort studies and two randomized controlled trials studying uncomplicated (n = 9), complicated (n = 18) and mixed cohorts (n = 6). Reduction in length of hospital stay was almost universally reported, with equivalent or improved complication rates. Key themes of protocols included antibiotic choice and duration, discharge criteria and post‐operative laboratory and radiographic testing. Rationalized analgesia is an underexplored aspect of protocol design, and a standardized definition of complicated appendicitis remains elusive. Conclusion Standardized care of childhood appendicitis has been shown to be safe and effective in several local and international centres. Next steps include investigation of a complicated appendicitis protocol that integrates rationalized analgesia in appendicectomy recovery, and development of a consistent classification scheme for complicated disease to aid in identification of amenable cohorts.

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Section: Resultsmentioning

confidence: 92%

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Do‐Wyeld

Rogerson

Court‐Kowalski

et al. 2019

ANZ Journal of Surgery

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show abstract

“…This has also been seen in the pediatric population; Alkhoury and colleagues 11 successfully treated 80% of 158 eligible patients with outpatient laparoscopic appendectomy, resulting in decreased length of stay without increases in complications and with good parent satisfaction with the technique. In a similar study, Putnam and colleagues 22 reported 332 pediatric patients (58% outpatient) treated without an increase in complications, but they did report an increase in readmission rates (4.2% outpatient vs 1.2% admitted postoperatively). With regard to the adult population, DuBois and colleagues 13 report instituting an outpatient appendectomy protocol during a span of 161 patients (45% outpatient).…”

Section: Discussionmentioning

confidence: 94%

Outpatient Laparoscopic Appendectomy: Feasible in a Public County Hospital?

Rosen

Inaba

et al. 2017

Journal of the American College of Surgeons

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“…Finally, we were unable to account for other confounders such as hospitals' teaching status or the use of care pathways although the impact of teaching status is debated and fewer than 20% of hospitals are reported to use care pathways. [31][32][33] In summary, privately-insured children in Texas who received specialized care were younger, had more severe disease, and were hospitalized longer but were less likely to undergo preoperative CT. Although outcomes were similar between children receiving specialized and nonspecialized care, there is likely a role for specialized care for younger children and for those with more severe disease.…”

Section: Discussionmentioning

confidence: 99%