Value Added from Same-day Discharge after Appendectomy for Children with Simple Appendicitis.

Area of Science:

• Pediatric Surgery
• Quality Improvement in Healthcare
• Clinical Practice Guidelines

Background:

• Same-day discharge after appendectomy for simple appendicitis offers benefits like enhanced parent satisfaction.
• General pediatric surgeons aimed to increase the rate of same-day discharge for pediatric appendectomies.
• Optimizing hospital resource utilization is crucial in pediatric surgical care.

Purpose of the Study:

• To improve the rate of same-day discharge for children with simple appendicitis following appendectomy.
• To evaluate the safety and impact of a clinical practice guideline on discharge timing.
• To assess changes in hospital length of stay and patient outcomes.

Main Methods:

• Implementation of a clinical practice guideline, surgeon-of-the-week model, and urgent operating room schedule.
• Prospective data collection using the National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric) database.
• Comparison of patient outcomes before (n=278) and after (n=264) intervention implementation.

Main Results:

• The monthly rate of same-day discharge increased from 32% to 75% post-implementation.
• Median postoperative length of stay decreased significantly (16.5 vs. 4.4 hours; P < 0.001).
• No significant differences were observed in emergency department returns or readmissions; reduced oral antibiotic use and low opioid prescribing were noted.

Conclusions:

• Quality improvement methodology and care standardization successfully increased same-day appendectomy discharges for children.
• The implemented changes did not negatively impact patient safety, evidenced by stable readmission rates.
• Significant hospital cost savings were achieved, with 140 hospital days saved in 21 months.