Cristen N Litz1, Laurie Stone2, Roberta Alessi3, Nebbie E Walford4, Paul D Danielson5, Nicole M Chandler6. 1. Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Outpatient Care Center, 601 5th Street South Dept 70-6600, St. Petersburg, FL 33701, USA. Electronic address: clitz@health.usf.edu. 2. Patient Safety and Quality Division, Johns Hopkins All Children's Hospital, Outpatient Care Center, 501 6th Avenue South, St. Petersburg, FL, 33701, USA. Electronic address: Lstone8@jhmi.edu. 3. Patient Safety and Quality Division, Johns Hopkins All Children's Hospital, Outpatient Care Center, 501 6th Avenue South, St. Petersburg, FL, 33701, USA. Electronic address: Ralessi1@jhmi.edu. 4. Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Outpatient Care Center, 601 5th Street South Dept 70-6600, St. Petersburg, FL 33701, USA. Electronic address: Beth.Walford@jhmi.edu. 5. Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Outpatient Care Center, 601 5th Street South Dept 70-6600, St. Petersburg, FL 33701, USA. Electronic address: Paul.Danielson@jhmi.edu. 6. Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Outpatient Care Center, 601 5th Street South Dept 70-6600, St. Petersburg, FL 33701, USA. Electronic address: Nicole.Chandler@jhmi.edu.
Abstract
BACKGROUND: In 2012, a same-day discharge protocol following appendectomy for acute appendicitis was initiated. Our objective was to determine the success of the protocol by reviewing the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) outcomes following protocol development. METHODS: The 2015 NSQIP-P Participant Use Data File was queried to identify patients with acute appendicitis who underwent appendectomy. Outcomes were compared to institutional outcomes. RESULTS: There were 154 institutional patients and 4973 from NSQIP-P centers. Institutional rate of outpatient management was higher compared to NSQIP-P (84% vs 48%, p<0.0001). Surgical length of stay was shorter compared to national rates (0.3±0.7 vs 1.1±1.9days, p<0.0001). There was no significant difference in the incidence of superficial (1.9% vs 1.0%, p=0.2), deep (0.6% vs 0.1%, p=0.17) or organ/space surgical site infections (1.3% vs 0.7%, p=0.31). The incidences of other complications (1.3% vs 0.6%, p=0.26) and 30-day readmissions (3.2% vs 2.6%, p=0.61) were similar. CONCLUSION: Outpatient management following appendectomy in children is possible with low morbidity and readmission rates. Comparison with other NSQIP-Pediatric centers suggests an opportunity to generalize this practice with considerable savings to the health care system. LEVEL OF EVIDENCE: Prognosis study, level II.
BACKGROUND: In 2012, a same-day discharge protocol following appendectomy for acute appendicitis was initiated. Our objective was to determine the success of the protocol by reviewing the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) outcomes following protocol development. METHODS: The 2015 NSQIP-P Participant Use Data File was queried to identify patients with acute appendicitis who underwent appendectomy. Outcomes were compared to institutional outcomes. RESULTS: There were 154 institutional patients and 4973 from NSQIP-P centers. Institutional rate of outpatient management was higher compared to NSQIP-P (84% vs 48%, p<0.0001). Surgical length of stay was shorter compared to national rates (0.3±0.7 vs 1.1±1.9days, p<0.0001). There was no significant difference in the incidence of superficial (1.9% vs 1.0%, p=0.2), deep (0.6% vs 0.1%, p=0.17) or organ/space surgical site infections (1.3% vs 0.7%, p=0.31). The incidences of other complications (1.3% vs 0.6%, p=0.26) and 30-day readmissions (3.2% vs 2.6%, p=0.61) were similar. CONCLUSION:Outpatient management following appendectomy in children is possible with low morbidity and readmission rates. Comparison with other NSQIP-Pediatric centers suggests an opportunity to generalize this practice with considerable savings to the health care system. LEVEL OF EVIDENCE: Prognosis study, level II.