Fast-track surgery for uncomplicated appendicitis in children: a matched case-control study

Area of Science:

• Pediatric Surgery
• Healthcare Management
• Clinical Protocols

Background:

• Standardized post-operative protocols enhance patient care efficiency and quality.
• This study evaluates a multidisciplinary criteria-led discharge protocol for pediatric appendicitis.
• Investigating protocol impact on length of stay, complications, and resource utilization.

Purpose of the Study:

• To assess the effectiveness of a criteria-led discharge protocol for uncomplicated pediatric appendicitis.
• To determine the protocol's impact on post-operative length of stay and patient outcomes.
• To evaluate cost savings and medication rationalization associated with the protocol.

Main Methods:

• A matched case-control study comparing 83 patients on the protocol with 83 historical controls.
• Protocol included limited post-operative antibiotics, avoidance of IV opioids, early diet/ambulation, and nurse-led discharge.
• Data collected from August 2015 to February 2016, comparing outcomes based on operative approach.

Main Results:

• A 29.2% reduction in median post-operative length of stay (19.6 vs. 27.7 hours; P < 0.001).
• Improved 24-hour discharge rate from 12% to 42% with no significant increase in complications (4.8% vs. 7.2%).
• Reduced opioid and antiemetic medication use, with projected annual cost savings of AUD$77,057.

Conclusions:

• The criteria-led discharge protocol significantly decreased length of stay and variation in pediatric appendicitis care.
• The protocol safely reduced medication use, preserved low morbidity, and generated substantial cost savings.
• These inexpensive, accessible protocols offer tangible benefits for diverse healthcare settings.