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Appendicitis-II: Diagnostic Studies and Management01:29

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Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
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Updated: Aug 12, 2025

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

Peter Juviler1, Nicole A Wilson2, Michael H Livingston2

  • 1Department of Surgery, University of Rochester Medical Center, Rochester, N.Y.

Pediatric Quality & Safety
|January 26, 2023
PubMed
Summary

Same-day discharge for children undergoing appendectomy for simple appendicitis is safe and effective. This quality improvement initiative significantly increased same-day discharges, reducing hospital stays without compromising patient safety or increasing readmissions.

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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.