Use of expedited post-operative protocol for children undergoing appendicostomy reduces length of hospitalization

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Colorectal Surgery

Background:

• Appendicostomy (ACE) is a surgical option for antegrade enemas in children with refractory constipation or fecal incontinence.
• Medical management failure necessitates surgical intervention for these pediatric patients.
• A new expedited post-operative protocol was implemented in 2019 to improve patient outcomes.

Purpose of the Study:

• To evaluate the short-term outcomes of an expedited post-operative protocol for appendicostomy (ACE).
• To compare outcomes between a historical cohort and patients managed under the expedited protocol.
• To assess the impact of the protocol on length of stay and clinical sequelae.

Main Methods:

• Retrospective comparative study including 30 pediatric patients undergoing ACE between 2017 and 2020.
• Patients were divided into a historical cohort (2017-2018) and an expedited protocol cohort (2019-present).
• Exclusion criteria included associated procedures like colon resection; primary outcome was length of stay.

Main Results:

• The expedited protocol group (Group B) demonstrated a significantly decreased length of stay (1 vs. 3 days, P=0.001).
• No significant differences were observed in 30-day surgical site infection rates (7.1% vs. 18.8%) or unplanned visits (15.4% vs. 18.8%).
• Indications included constipation (50%) and anorectal malformation with constipation/incontinence (43%).

Conclusions:

• The expedited post-operative protocol for appendicostomy (ACE) effectively reduces length of stay.
• This protocol does not lead to significant adverse clinical sequelae.
• The findings support the adoption of expedited recovery pathways for pediatric ACE patients.