Same-Day Discharge for Paediatric Uncomplicated Appendicitis in Australia

Acute appendicitis is the most common paediatric emergency presentation requiring timely surgical intervention. The Sydney Children's Hospital Network (SCHN) noted in their National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) data that their appendicectomy postoperative length of stay (LOS) was longer than that of other hospitals.

NSQIP-P reports are calculated from case reviews with a 30-day post-operative follow-up. From 2020 to 2022, the post-operative LOS for uncomplicated appendicectomy at SCHN was a median of 24 h (n = 714). A quality improvement project was initiated using Clinical Redesign Methodology. The project team developed an Uncomplicated Appendicectomy Guideline to standardize care. The Guideline also included a criteria-led discharge that could be applied after 6 h of post-operative recovery. Comprehensive information was provided for parents/carers on discharge.

In 2024, the median postoperative LOS was reduced from 24 to 16 h (n = 185). This represents a statistically significant reduction in post-operative length of stay of 33% (p < 0.001). There were no statistically significant increase in post-operative readmissions (p = 0.95) or in NSQIP-P morbidity rates, although there was an increase in post-operative Emergency Department presentations noted, from a median of 7-10 annual presentations (p < 0.05, n = 444). There was positive feedback from parents/carers with the earlier discharge (n = 16). Parents/carers who received the discharge information sheet reported that they were better informed about their child's care. Staff in focus groups highlighted a greater autonomy in post-operative care (n = 24).

Paediatric patients with uncomplicated appendicitis can be safely discharged from 6 h post-operatively with comprehensive discharge information.