Use of expedited post-operative protocol for children undergoing appendicostomy reduces length of hospitalization

An appendicostomy (ACE) is a surgical option for antegrade enemas in children with severe constipation and/or fecal incontinence who have failed medical management.  In 2019, we initiated an expedited post-operative protocol and sought to examine our short-term outcomes compared with our historical...

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Bibliographic Details
Published in:Journal of pediatric surgery 2022-03, Vol.57 (3), p.406-409
Main Authors: Short, Scott S., Zobell, Sarah, Gaddis, Katherine, Mammen, Lija, Wynne, Elisabeth, Rollins, Michael D.
Format: Article
Language:English
Subjects:
Appendicostomy
Child
Colostomy
Constipation
Constipation - etiology
Constipation - therapy
Encopresis
Enema
Fecal incontinence
Fecal Incontinence - etiology
Hospitalization
Humans
Retrospective Studies
Treatment Outcome
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Summary:An appendicostomy (ACE) is a surgical option for antegrade enemas in children with severe constipation and/or fecal incontinence who have failed medical management.  In 2019, we initiated an expedited post-operative protocol and sought to examine our short-term outcomes compared with our historical cohort. A retrospective review was performed of all children undergoing ACE between 2017 and 2020. Children were excluded if they underwent an associated procedure (e.g. colon resection). Patients were divided into two cohorts: historical cohort (2017–2018, Group A) and the expedited protocol (2019 to present, Group B). The primary outcome was length of stay. 30 patients met inclusion (Group A = 16, Group B = 14). The most common indications for ACE were constipation (50%) and constipation or fecal incontinence associated with anorectal malformation (43%). Group B experienced a decreased length of stay (1 vs 3 days, P = 0.001) without differences in 30-day surgical site infection (7.1% vs 18.8%, p = 0.61) or unplanned visit (15.4% vs 18.8%, p = 1.0). Group B had a higher prevalence of MiniACE® button placed through the appendix vs. Malone (42.8% vs 12.5%, p = 0.10). Our expedited post-op protocol decreased length of stay without other significant adverse clinical sequelae. Retrospective Comparative Study, Level III.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2021.03.053