A dynamic postoperative protocol provides efficient care for pediatric patients with non-ruptured appendicitis

Area of Science:

• Pediatric Surgery
• Hospital Management
• Clinical Protocols

Background:

• Postoperative management for pediatric non-ruptured appendicitis is inconsistent.
• Current practices often involve extended hospital stays and routine postoperative antibiotics.

Purpose of the Study:

• To evaluate a new criteria-based protocol for managing pediatric patients with non-ruptured appendicitis.
• To reduce length of stay and healthcare costs by eliminating postoperative antibiotics and enabling earlier discharge.

Main Methods:

• A retrospective study comparing patients before and after protocol implementation (May 2012-April 2013).
• Data collected on length of stay, total cost of care, readmission rates, and postoperative abscess rates.
• Protocol utilized bedside nurses to assess patient readiness for discharge.

Main Results:

• The new protocol reduced average length of stay from 40.1 to 23.5 hours.
• Total cost of care decreased from $5783 to $4499 per patient (p<0.001).
• No significant changes were observed in hospital readmission or postoperative abscess rates.

Conclusions:

• The implemented protocol effectively reduces length of stay and costs for pediatric appendicitis.
• Eliminating postoperative antibiotics and utilizing nurse-led discharge assessments are key components of the protocol's success.
• This approach demonstrates a safe and cost-effective method for managing pediatric non-ruptured appendicitis.