Convalescent phase outpatient parenteral antiinfective therapy for children with complicated appendicitis
J S Bradley1, C E Behrendt, A C Arrieta
1Division of Infectious Diseases, Children's Hospital, San Diego, CA, USA. jbradley@chsd.org
Insights
Discharging stable children with complicated appendicitis home for parenteral antibiotic therapy reduces hospital stays and costs. This approach, outpatient parenteral anti-infective therapy (OPAT), proved safe and effective for pediatric patients.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Health Economics
Background:
- Children with complicated appendicitis often require prolonged hospitalization for intravenous antibiotics after initial treatment.
- This leads to increased healthcare costs and resource utilization.
- An alternative approach is needed to manage these patients effectively.
Purpose of the Study:
- To investigate the outcomes of discharging children with complicated appendicitis home to complete parenteral antibiotic therapy.
- To assess the safety, efficacy, and cost-effectiveness of outpatient parenteral anti-infective therapy (OPAT) in this pediatric population.
Main Methods:
- A prospective study involving children aged 1-17 with complicated appendicitis (peritonitis or abscess).
- Eligible children received meropenem via OPAT at home, administered by family and supervised by nurses.
- Patients served as their own controls to evaluate hospitalization reduction and cost savings.
Main Results:
- 87 children received OPAT, averaging 4.5 days, with discharge on postoperative day 4.
- Readmission occurred in 7% of patients for complications (e.g., bowel obstruction, abscess).
- OPAT reduced hospitalization by 42% and saved a median of $2908 per patient.
Conclusions:
- Outpatient parenteral anti-infective therapy (OPAT) is a safe and cost-effective alternative for stable children with complicated appendicitis.
- This strategy allows for reduced hospitalization and significant cost savings.
- OPAT facilitates early discharge while ensuring continued antibiotic treatment.
Background:
Children with a perforated or gangrenous appendix become clinically stable after medical and/or surgical therapy but often remain in the hospital solely to complete parenteral antibiotic therapy. This prospective study investigates the outcomes when children who meet specified criteria are discharged to complete parenteral antibiotic therapy at home.
Methods:
Children age 1 to 17 years with appendicitis complicated by generalized peritonitis or intraabdominal abscess were eligible to participate. Subjects whose fever was decreasing, who were able to tolerate oral liquids and for whom further parenteral antibiotic therapy was deemed necessary were discharged from the hospital to receive outpatient parenteral antiinfective therapy (OPAT) with meropenem. Therapy was administered by a family member and supervised by home care nurses. Study personnel visited the home daily to collect data on adverse events, compliance and resource utilization. Pa tients served as their own controls in models of reduced hospitalization and net cost savings.
Results:
Discharged on average on the fourth postoperative day, 87 children received 4.5 +/- 2.1 days of OPAT. Six (7%) children were subsequently readmitted for complications including bowel obstruction (4 children), intraabdominal abscess (1 child) and pleural effusion (1 child). Another child developed a viral syndrome during OPAT. All other patients recovered uneventfully. Six (7%) children discontinued meropenem prematurely because of rash (4 patients) or diarrhea (2 patients). According to models in which each day of OPAT replaced a day of inpatient care, discharge to OPAT reduced hospitalization by 42 +/- 15% and saved a median of $2908 (10th to 90th percentile range, $1,077 to $4,707) per patient.
Conclusion:
Convalescent phase OPAT is a cost-effective alternative to continued hospitalization for children with complicated appendicitis who are clinically stable yet require further parenteral antibiotic therapy.
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