Routine Same-Day Discharge After Acute or Interval Appendectomy in Children

Alkhoury, Fuad; Malvezzi, Leopoldo; Knight, Colin G.; Diana, Jeannette; Pasarón, Raquel; Mora, JoAnne; Aserlind, Alexandra; Stylianos, Steven; Burnweit, Cathy

doi:10.1001/archsurg.2012.132

Cited by 42 publications

(41 citation statements)

References 15 publications

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“…The more predictable post‐operative course for uncomplicated appendicitis is amenable to an expedited clinical pathway. Some protocols enabled routine same‐day discharge . 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 .…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Restriction to two post‐operative doses was reported by Cundy et al , which resulted in no significant increase in abscess rate or surgical site infection. Further restriction of antibiotic administration to a single peri‐operative dose only has been reported with findings of acceptable rates of complications and readmissions …”

Section: Resultsmentioning

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%

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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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“…Some authors feel that appendicectomy is an outpatient operation. 11 Others consider appendicectomy unnecessary in many cases. 12 As surgeons grapple with these paradigm shifts, it is valuable to review the history of appendicectomy.…”

Section: Introductionmentioning

confidence: 99%

A history of the treatment of appendicitis in children: lessons learned

Hamill

Hill

2016

ANZ Journal of Surgery

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During the latter half of the 19th century, surgeons increasingly reported performing appendicectomies. Fitz from Harvard, Groves from Canada and Tait from Britain all recorded successful removal of the appendix. McBurney described the point of maximal tenderness in classic appendicitis and also the muscle-splitting incision centred on this point. Priority is given to McArthur in describing the lateral muscle-splitting incision. The direction of the cutaneous incision was later modified by Elliott and Lanz. Incisions that healed well were essential to recovery. Appendicectomy became a 'fashionable' operation after the London surgeon, Treves, removed the appendix of King Edward VII. Through the 20th century, the mortality from appendicitis fell notably with the advent of sulphonamide and penicillin, improvements in fluid therapy and safer anaesthesia. By 1990, diagnostic delay was the main cause of death. Semm performed the first laparoscopic appendicectomy in 1990, roundly criticized at the time for what is now a routine procedure. We view contemporary debates on the indications for appendicectomy, the best approach and how to optimize recovery in the light of the history of this intriguing disease.

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“…In 1983, along with advances in endoscopic surgery, LA was first described as an optional technique for removing the appendix. LA can be performed using one or more laparoscopy ports [7,8].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic or Open Appendectomy for Pediatric Appendicitis?

Elofsson¹,

Gemryd²,

Arnbjörnsson³

et al. 2016

MOJS

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Background: This study aimed to compare open appendectomy (OA) and laparoscopic appendectomy (LA) in children by analyzing the differences in outcomes between the two techniques. Materials and Methods:This was a single-institution retrospective study. Data were collected from the medical records of all children <15 years of age who underwent an appendectomy from 2006 through 2014. Preoperative parameters, appendicitis severity, surgery time, complications, pain treatment, and postoperative outcome including days of hospital stay were collected. LA was performed with a two-or three-port technique, and a McBurney incision was adopted for OA. Conversions were regarded as OA.Results: A total of 406 appendectomies were performed during the study period, 146 (36%) OA (61 conversions) and 260 (64%) LA. No differences were found between the two groups regarding surgery time, operative and postoperative complications, and postoperative pain treatment. In cases of Phlegmonous appendicitis, LA was associated with a significantly shorter median hospital stay than was OA (1 and 1.8 days, respectively; p < 0.01). Healthy and Phlegmonous appendices were more commonly treated with LA (p < 0.01 for both); gangrenous, perforated, and abscessed appendices were more commonly treated with open surgery (p = 0.02, p < 0.01, and p < 0.01, respectively). Conclusion:The study identified no disadvantages of LA compared with OA. Therefore, LA should be the preferred technique because it is associated with a shorter hospital stay for patients with Phlegmonous appendicitis and also allows inspection of the abdominal cavity, a major diagnostic advantage. result from lack of experience in the technique. This difference will decrease as surgeons receive more training in endoscopic surgery [15]. Keywords:Since the introduction of LA the use of this surgical method has increased, making it the method of first choice [9]. The long transition period and the continued use of both techniques are due to the split opinion among surgeons and the lack of experience in endoscopic surgery [9]. According to a 2008 national cohort study of children and adults, 33% of appendectomies began as LA and 66% began as OA [16]. In 1992, the rate of intended LA was only 4%; prior to that year the procedure was performed only sporadically [16]. In patients aged 0-9 years, 4% of appendectomies performed from 1992 to 2008 were laparoscopic; in those aged 10-19 years, the rate was 18% [16]. LA was performed less commonly in children than in the population as a whole (the LA rate for the total population from 1992 to 2008 was 20%) [16].The aim of this study was to compare OA and LA in children with regard to perioperative parameters and postoperative outcome. The intention was to provide information of value to surgeons making the decision to perform appendectomy for a child. The question is whether LA or OA leads to the better outcome when treating pediatric appendicitis. Materials and Methods Settings and childrenAll children underwent surgery at the Department o...

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Routine Same-Day Discharge After Acute or Interval Appendectomy in Children

Abstract: Hypothesis:The outcomes of and parental satisfaction with same-day discharge in children undergoing laparoscopic appendectomy warrant making it the usual and customary pathway.

Cited by 42 publications

References 15 publications

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

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

A history of the treatment of appendicitis in children: lessons learned

Laparoscopic or Open Appendectomy for Pediatric Appendicitis?

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