A prospective same day discharge protocol for pediatric appendicitis: Adding value to a common surgical condition
Yangyang R Yu1, Carolyn M Smith2, Kimberly K Ceyanes1
1Division of Pediatric Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
Insights
Same day discharge (SDD) for pediatric simple appendicitis is safe and effective. This protocol reduces hospital length of stay and costs while maintaining patient satisfaction and low complication rates.
Area of Science:
- Pediatric Surgery
- Health Economics
- Clinical Pathways
Background:
- Standardized clinical pathways for simple appendicitis have demonstrated benefits in reducing length of stay and healthcare costs.
- A same-day discharge (SDD) protocol offers potential for further optimization of care for pediatric appendicitis.
Purpose of the Study:
- To prospectively evaluate the safety, efficacy, and economic impact of a same-day discharge (SDD) protocol for children with simple appendicitis.
- To compare resource utilization, patient satisfaction, and costs between SDD and non-SDD patients.
Main Methods:
- Prospective cohort study of children undergoing laparoscopic appendectomy for simple appendicitis.
- Comparison of length of stay, 30-day resource utilization (ED visits, readmissions), patient satisfaction, and hospital costs between SDD and non-SDD groups.
- Level II evidence based on prognosis study design.
Main Results:
- 185 out of 602 (31%) children were successfully discharged on the same day.
- SDD significantly reduced overall length of stay (17.1 vs. 31.2 hours) and hospital costs ($8073 vs $8424).
- Complication rates, ED visits, and readmissions were not significantly different between groups. Patient satisfaction was high (9.4/10).
Conclusions:
- Same-day discharge is a safe and satisfactory management option for select pediatric patients with simple appendicitis.
- Implementing an SDD protocol generates significant value for the healthcare system through cost savings and efficient resource utilization.
Purpose:
Standardized clinical pathways for simple appendicitis decrease length of stay and result in cost savings. We performed a prospective cohort study to assess a same day discharge (SDD) protocol for children with simple appendicitis.
Methods:
All children undergoing laparoscopic appendectomy for simple appendicitis after protocol implementation (February 2016 to January 2017) were assessed. Length of stay (LOS), 30-day resource utilization (ED visits and hospital readmissions), patient satisfaction, and hospital accounting costs for SDD were compared to non-SDD patients.
Results:
Of 602 children treated at our institution, 185 (31%) were successfully discharged per protocol. SDD patients had longer median PACU duration (3.0 vs. 1.0h, p<0.001), but postoperative LOS (4.4 vs. 17.4h, p<0.001) and overall LOS (17.1 vs. 31.2h, p<0.001) were significantly shorter. Complication rates (1.6% vs. 3.1%), ED visits (4.3% vs. 6.0%), and readmissions (0.5% vs. 2.4%) were not significantly different for SDD compared to non-SDD patients. However, SDD decreases total cost of an appendectomy episode ($8073 vs $8424, p=0.002), and patients report high satisfaction with their hospital experience (mean 9.4 out of 10).
Conclusions:
Safe and satisfactory outpatient management of pediatric simple appendicitis is achievable with appropriate patient selection. An SDD protocol can lead to significant generation of value to the healthcare system.
Level Of Evidence:
Prognosis study, Level II.
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