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An Enhanced Recovery Protocol that Facilitates Same-day Discharge for Simple Laparoscopic Appendectomies
Shabana Z Shafy1, Rebecca Miller1, Joshsua C Uffman1,2
1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Pediatric Quality & Safety
|February 4, 2020
Summary
A new protocol for pediatric laparoscopic appendectomy significantly increased same-day discharges by reducing nausea and vomiting. Protocol compliance was linked to a higher likelihood of early discharge, optimizing hospital bed use.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Hospital Operations
Background:
- Acute appendicitis is a common pediatric surgical emergency.
- Laparoscopic appendectomy (LA) is the standard surgical approach.
- Postoperative nausea and vomiting (PONV) often prolongs hospital stays after LA.
Purpose of the Study:
- To implement and evaluate a standardized protocol aimed at reducing PONV.
- To facilitate same-day discharge for pediatric patients undergoing LA.
- To assess the impact of protocol compliance on discharge rates.
Main Methods:
- A multidisciplinary team developed a protocol to manage PONV and enable same-day discharge.
- The protocol was implemented in November 2014, with a revision in June 2016.
- Patient data from 691 pediatric LA cases (November 2014 - August 2017) were analyzed.
Main Results:
- 74% of patients were discharged on the same day as their LA.
- Protocol-compliant patients had a higher same-day discharge rate (79%) compared to non-compliant patients (69%).
- Compliance with the protocol was associated with an increased likelihood of same-day discharge (OR = 1.7).
Conclusions:
- Implementing the LA protocol significantly increased same-day hospital discharge rates for compliant pediatric patients.
- The protocol effectively reduced PONV, contributing to earlier discharges.
- This strategy led to a 45% reduction in the need for inpatient beds.
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