Reducing resource utilization for patients with uncomplicated appendicitis through use of same-day discharge and elimination of postoperative antibiotics
| Autor: | Roshan J. D'Cruz, Charles D. Vinocur, Courtney L. Devin, Sharon L. English, Allison F. Linden, Kirk W. Reichard, Loren Berman |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class Population Antibiotics 03 medical and health sciences 0302 clinical medicine Postoperative Complications 030225 pediatrics medicine Appendectomy Humans education Child Retrospective Studies education.field_of_study business.industry General surgery General Medicine Evidence-based medicine Perioperative Emergency department Length of Stay medicine.disease Appendicitis Patient Discharge Anti-Bacterial Agents Treatment Outcome 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health Surgery Complication business Resource utilization |
| Zdroj: | Journal of pediatric surgery. 55(12) |
| ISSN: | 1531-5037 |
| Popis: | 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 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).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.Retrospective comparative study.Level III. |
| Databáze: | OpenAIRE |
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