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

Autor: Devin CL; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA. Electronic address: Courtney.Devin@jefferson.edu., D'Cruz R; Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE., Linden AF; Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE., English S; Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE., Vinocur CD; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA; Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE., Reichard KW; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA; Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE., Berman L; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA; Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2020 Dec; Vol. 55 (12), pp. 2591-2595. Date of Electronic Publication: 2020 Apr 17.
DOI: 10.1016/j.jpedsurg.2020.04.003
Abstrakt: Background: 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.
Methods: 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.
Results: 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 < 0.0001). There were no increases in postoperative complications, such as superficial (2.6% vs 1.1%, p = 0.19) or organ-space surgical-site infection (1.6% vs 0.4%, p = 0.14), percutaneous drain placement (1.3% vs 0%, p = 0.06), postoperative ED visits (5.5% vs 5.2%, p = 0.87) or readmission (3.3% vs 1.5%, p = 0.17).
Conclusions: These findings suggest that incorporating same-day discharge for simple appendicitis and eliminating postoperative antibiotics for children with gangrenous appendicitis does not increase complication rates. Implementation of similar pathways across institutions has the potential to significantly reduce resource utilization for children undergoing appendectomy for uncomplicated appendicitis.
Type of Study: Retrospective comparative study.
Level of Evidence: Level III.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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