Outcome of early discharge protocol after appendectomy for pediatric acute appendicitis

Abstract

The present early discharge protocol is safe and effective for the management of acute non-perforated appendicitis.

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

“…Antibiotic selection and dosage were key protocol components in most studies, but there is continuing disparity and debate regarding antibiotic selection (Table S1). Some favour monotherapy with piperacillin‐tazobactam, cefmetazole or cefoxitin, while others prefer multi‐agent therapy with combinations such as ceftriaxone and metronidazole . Many protocols focussed efforts on rationalizing post‐operative antibiotic duration of therapy.…”

“…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 …”

“…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 to 38.5 degrees Celsius and criteria were either >24 hours afebrile or apyrexia at the time of completion of other discharge criteria milestones. Other criteria reported throughout the literature included dryness of wound dressings, no requirement for antiemetics before discharge, uneventful voiding and independent ambulation …”

“…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).…”

“…In addition to tolerance of oral analgesia, several common factors were identified. 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.…”