Impact of outpatient management following appendectomy for acute appendicitis: An ACS NSQIP-P analysis

Litz, Cristen N.; Stone, Laurie; Alessi, Roberta; Walford, Nebbie E.; Danielson, Paul D.; Chandler, Nicole M.

doi:10.1016/j.jpedsurg.2017.06.023

Cited by 15 publications

(14 citation statements)

References 14 publications

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“…Although the ability to tolerate oral analgesia was a frequent discharge criterion, only two identified protocols included guidance for rationalized analgesic prescribing and both endorsed as‐needed dosing only …”

Section: Resultsmentioning

confidence: 99%

“…In addition to tolerance of oral analgesia, several common factors were identified. These include resumption of oral fluid intake or regular diet, satisfactory period without fever and normalization of vital signs . Of all vital signs, body temperature was the most frequently reported parameter of interest.…”

Section: Resultsmentioning

confidence: 99%

“…Further restriction of antibiotic administration to a single perioperative dose only has been reported with findings of acceptable rates of complications and readmissions. [14][15][16]18,19 Although the ability to tolerate oral analgesia was a frequent discharge criterion, [16][17][18][19][20][21][22] only two identified protocols included guidance for rationalized analgesic prescribing and both endorsed as-needed dosing only. 17,20 Standardized discharge criteria varied in detail and interpretation of readiness for safe discharge (Table S2).…”

Section: Uncomplicated Appendicitismentioning

confidence: 99%

“…These include resumption of oral fluid intake 16,[20][21][22] or regular diet, 19 satisfactory period without fever 17,[19][20][21][22][23] and normalization of vital signs. 16,17,22 Of all vital signs, body temperature was the most frequently reported parameter of interest. The threshold temperature that constituted a fever ranged from 37.5 20,21 to 38.5 16,19 degrees Celsius and criteria were either >24 hours afebrile or apyrexia at the time of completion of other discharge criteria milestones.…”

Section: Uncomplicated Appendicitismentioning

confidence: 99%

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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: 99%

Section: Resultsmentioning

confidence: 99%

Section: Uncomplicated Appendicitismentioning

confidence: 99%

Section: Uncomplicated Appendicitismentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

“…[16] Laparoscopic appendectomy is a safe surgical procedure, and due to the fear of perforation, urgent/emergent surgery is accepted as a standard treatment option. [17,18] The aim of the present study was to investigate the association between different time periods of the day (daytime, early after-hours, and nighttime) at which urgent surgery was performed and morbidity or mortality during the intraoperative and postoperative periods. We hypothesized that urgent nighttime surgery is associated with higher intraoperative and postoperative morbidity and also causes longer hospital stays and more unplanned critical care admissions.…”

Section: Introductionmentioning

confidence: 99%