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Discharge planning for children with perforated appendicitis.

G A Birken, K P Schropp, E T Boles

    Journal of Pediatric Surgery
    |July 1, 1986
    PubMed
    Summary
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    Discharging children with perforated appendicitis after antibiotics, without a mandatory 48-hour observation, is safe and cost-effective. This approach avoids unnecessary hospital stays for uncomplicated cases, saving significant costs.

    Area of Science:

    • Pediatric Surgery
    • Clinical Management
    • Healthcare Economics

    Background:

    • Optimal management of perforated appendicitis in children is debated.
    • Traditional discharge criteria include a 48-hour post-antibiotic observation period.
    • Cost-containment initiatives question the necessity of prolonged inpatient stays.

    Purpose of the Study:

    • To evaluate the medical soundness and cost-effectiveness of current discharge policies for perforated appendicitis.
    • To determine if a 48-hour inpatient observation period post-antibiotics is necessary for uneventful recoveries.

    Main Methods:

    • Prospective analysis of 87 children with perforated appendicitis.
    • Review of patient records to assess recovery, complications, and hospital stay duration.

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  • Cost analysis based on average daily hospital charges.

    • Main Results:

    • 86% (75/87) of children recovered uneventfully.
    • Complications in 12 patients were identified early by fever, leukocytosis, and elevated band counts.
    • Uneventful recovery cases spent an average of 142 additional days in hospital post-antibiotics, costing $71,897.44 unnecessarily.

    Conclusions:

    • Inpatient observation following antibiotic cessation is not necessary for children with uncomplicated perforated appendicitis.
    • Current discharge policies are neither medically necessary nor cost-effective for these patients.
    • Early identification of complications is possible through clinical and laboratory markers, negating prolonged observation.