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

David E Skarda1, Kathy Schall1, Michael Rollins1

  • 1Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.

Journal of Pediatric Surgery
|January 20, 2015
PubMed

Insights

A new protocol for pediatric appendicitis significantly reduced hospital stays and costs by eliminating postoperative antibiotics and using bedside nurses to assess patient readiness for discharge. This approach maintained safety without increasing readmissions or complications.

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.
Abstract

Keywords:
AppendicitisCostLength of stayNon-rupturedPediatricProtocol

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