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Facilitating use of same-day discharge after appendectomy in children: Implementation of an evidence-based

Radek Buss1, Emmanuel L Abebrese2, Kathleen Leack2

  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

American Journal of Surgery
|July 8, 2025
PubMed

Insights

Same-day discharge (SDD) for pediatric appendicitis significantly increased after implementing a new pathway. This approach reduced hospital stays and costs without impacting patient safety or readmissions.

Area of Science:

  • Pediatric Surgery
  • Health Services Research

Background:

  • Same-day discharge (SDD) after laparoscopic appendectomy is associated with reduced hospital stays and costs.
  • Implementation of an SDD pathway for children with uncomplicated appendicitis (UA) was studied at a children's hospital.
  • The study aimed to increase SDD utilization while accounting for COVID-19 related changes.

Purpose of the Study:

  • To detail the implementation of a new SDD pathway for pediatric uncomplicated appendicitis.
  • To evaluate the impact of the pathway on SDD utilization.
  • To assess safety and efficiency outcomes during the COVID-19 pandemic.

Main Methods:

  • Lean Six Sigma methodology was used to identify factors influencing SDD utilization.
  • A multidisciplinary team developed and implemented a new post-operative pathway in April 2021.
  • Pathway effectiveness was re-evaluated in April 2022.

Main Results:

  • SDD utilization increased from 51.8% to 82.8% (p < 0.001) among 1258 children.
  • Hospital charges decreased by $873 and length of stay by 5.7 hours (p < 0.001).
  • No increase in readmissions or emergency department visits was observed; SDD odds increased by 76% (p < 0.001) after adjustments.

Conclusions:

  • A new evidence-based pathway successfully increased SDD utilization in pediatric uncomplicated appendicitis.
  • The pathway implementation was safe and effective, even during the COVID-19 pandemic.
  • This approach offers a model for reducing healthcare costs and improving efficiency in pediatric surgery.
Abstract

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