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

There is controversy over certain aspects of post-appendectomy care for children with uncomplicated appendicitis. Some institutions have embraced the practice of same-day discharge after appendectomy, while others are hesitant due to concerns about increased readmissions or emergency department (ED)...

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Bibliographic Details
Published in:Journal of pediatric surgery 2020-12, Vol.55 (12), p.2591-2595
Main Authors: Devin, Courtney L., D'Cruz, Roshan, Linden, Allison F., English, Sharon, Vinocur, Charles D., Reichard, Kirk W., Berman, Loren
Format: Article
Language:English
Subjects:
Appendectomy
Checklists
Pathways
Quality improvement
Resource utilization
Standardization
Uncomplicated appendicitis
Value-based care
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Summary:There is controversy over certain aspects of post-appendectomy care for children with uncomplicated appendicitis. Some institutions have embraced the practice of same-day discharge after appendectomy, while others are hesitant due to concerns about increased readmissions or emergency department (ED) visits. Similarly, some surgeons have transitioned to treating gangrenous appendicitis with a single perioperative dose, while others are concerned about increased risk of infection in this population. We developed a pathway for the management of patients undergoing appendectomy for uncomplicated acute appendicitis which included same-day discharge and elimination of postoperative antibiotics for patients with gangrenous appendicitis. We compared outcomes for children treated at our institution before and after implementation of the protocol. We identified 575 patients undergoing appendectomy for uncomplicated appendicitis (307 pre- and 268 post-protocol). We observed a significant decrease in postoperative length-of stay (10.6 to 2.6 h, p 
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2020.04.003