Reducing resource utilization for patients with uncomplicated appendicitis through use of same-day discharge and elimination of postoperative antibiotics

Devin, Courtney L.; D'Cruz, Roshan; Linden, Allison F.; English, Sharon; Vinocur, Charles D.; Reichard, Kirk W.; Berman, Loren

doi:10.1016/j.jpedsurg.2020.04.003

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…Various clinical practice guidelines (CPG) or clinical pathways were studied to reduce SSI following appendectomy. Two studies examined the effect of same-day discharge CPG, and no significant reduction in SSIs was observed before or after implementation 33,34 . However, Putnam et al found a significant reduction in SSI during their first audit but returned to their usual rates 34 .…”

Section: Clinical Practice Guidelines/pathwaysmentioning

confidence: 99%

Implemented Interventions in Preventing Surgical Site Infection in Pediatric Appendicitis Patients: A Scoping Review

Hebballi,

Sutyak,

Broussard

et al. 2024

Preprint

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Objective: Surgical site infections (SSIs), especially deep/organ-space SSIs, are common and serious complications following appendectomy. This review aimed to explore the interventions that have been implemented to reduce the risk of SSIs in pediatric appendicitis patients. Methods: A literature search was performed using PubMed, Cochrane, and Embase databases of studies in English published between January 01, 1973, and April 30, 2023. Studies on pediatric patients (≤ 18 years) with appendicitis that described any interventions aimed at reducing SSIs and reported SSIs as an outcome were included. Results: A total of 56 studies were included in the final scoping review. The interventions included antibiotic stewardship, clinical practice guidelines/pathways, different surgical approaches, timing of appendectomy, irrigation or lavage, use of peritoneal drains, timing of wound closure and management, parenteral nutrition, pain management, and outpatient management. Conclusion: A wide variety of interventions have been studied in pediatric appendicitis patients to reduce the SSI rates. Very few publications have studied low-cost, widely available intraoperative interventions to reduce deep/organ-space SSIs.

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Section: Clinical Practice Guidelines/pathwaysmentioning

confidence: 99%

Implemented Interventions in Preventing Surgical Site Infection in Pediatric Appendicitis Patients: A Scoping Review

Hebballi,

Sutyak,

Broussard

et al. 2024

Preprint

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“…The full text of 43 studies was retrieved and thoroughly read. Finally, 13 studies comprising of 32,021 children and adolescents were included in the review (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31).…”

Section: Selection Of Articlesmentioning

confidence: 99%

Feasibility of Same-Day Discharge After Appendectomy in Pediatric Patients: A Systematic Review and Meta-Analysis

Zheng

2022

Front. Pediatr.

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BackgroundTo compare the readmission rate, rate of urgent/unplanned visits to emergency, complication rate along with cost of health care among children and adolescents who were discharged the same day following a laparoscopic appendectomy and those who were not discharged on the same day.MethodsA systematic search was performed in the PubMed, Embase, and Scopus databases. Randomized controlled trials and studies, observational in design, were considered for inclusion. The included studies were conducted in children and adolescents with uncomplicated appendicitis undergoing laparoscopic appendectomy and compared outcomes of interest between patients that were discharged the same day (SDD group) following the operation and patients that were discharged within 2 days post-operatively (non-SSD group). Statistical analysis was performed using STATA software. Effect sizes were reported as pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals.ResultsA total of 13 studies with 32,021 children and adolescents were included. There was no significant difference in the risks of unplanned visit to the emergency department (OR 1.07, 95% CI: 0.78, 1.47), readmission (OR 0.83, 95% CI: 0.66, 1.05), reoperation/re-intervention (OR 1.73, 95% CI: 0.19, 16.2) and complications (OR 0.84, 95% CI: 0.67, 1.06) in both groups of patients. Patients in the SDD group had slightly lower risk of wound infection/complication (OR 0.74, 95% CI: 0.57, 0.96) compared to patients in the non-SDD group. Those with SDD had to incur comparatively lesser hospital expense (in USD) compared to those with no SDD (WMD −2587.4, 95% CI: −4628.3, −546.6).ConclusionIn children and adolescents with uncomplicated acute appendicitis undergoing laparoscopic appendectomy, same-day discharge is not associated with increased readmission risk, unplanned visits to emergency, and complications. Further, SDD is associated with lower cost of hospital care. Adoption of SDD in this subset of children and adolescents may be encouraged.Systematic Review Registration[www.crd.york.ac.uk/prospero], identifier [CRD420 22320539].

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“…Our mean length of stay following an uncomplicated appendectomy in our children's hospital was 2.5 days. Recent studies have demonstrated reductions in the length of stay following an uncomplicated appendectomy using clinical pathways [17][18][19]. We hypothesized that the creation of a post-operative clinical pathway process for children following an uncomplicated appendectomy at our institution would drive a reduction in the mean post-operative length of stay to 2.0 or fewer days.…”

Section: Introductionmentioning

confidence: 99%

Reducing Post-Operative Hospital Length of Stay following Uncomplicated Appendectomy in Pediatric Patients: A Prospective Clinical Study

Jeski,

Stanger,

Schafer

et al. 2024

Healthcare

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An uncomplicated appendectomy in children is common. Safely minimizing the post-operative length of stay is desirable from hospital, patient, and parent perspectives. In response to an overly long mean length of stay following uncomplicated appendectomies in children of 2.5 days, we developed clinical pathways with the goal of safely reducing this time to 2.0 or fewer days. The project was conducted in an urban, academic children’s hospital. The pathways emphasized the use of oral, non-narcotic pain medications; the education of parents and caregivers about expectations regarding pain control, oral food intake, and mobility; and the avoidance of routine post-operative antibiotic use. A convenience sample of 46 patients aged 3–16 years old was included to evaluate the safety and efficacy of the intervention. The mean post-operative length of stay was successfully reduced by 80% to 0.5 days without appreciable complications associated with earlier discharge. The hospital length of stay following an uncomplicated appendectomy in children may be successfully and safely reduced through the use of carefully devised, well-defined, well-disseminated clinical pathways.

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Reducing resource utilization for patients with uncomplicated appendicitis through use of same-day discharge and elimination of postoperative antibiotics

Cited by 9 publications

References 17 publications

Implemented Interventions in Preventing Surgical Site Infection in Pediatric Appendicitis Patients: A Scoping Review

Implemented Interventions in Preventing Surgical Site Infection in Pediatric Appendicitis Patients: A Scoping Review

Feasibility of Same-Day Discharge After Appendectomy in Pediatric Patients: A Systematic Review and Meta-Analysis

Reducing Post-Operative Hospital Length of Stay following Uncomplicated Appendectomy in Pediatric Patients: A Prospective Clinical Study

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