Same-Day Discharge for Paediatric Uncomplicated Appendicitis in Australia

Area of Science:

• Pediatric Surgery
• Quality Improvement Science
• Health Services Research

Background:

• Acute appendicitis is a common pediatric surgical emergency.
• Sydney Children's Hospital Network (SCHN) had longer appendectomy postoperative lengths of stay (LOS) compared to other hospitals.
• A quality improvement project was initiated to address this disparity.

Purpose of the Study:

• To reduce the postoperative length of stay (LOS) for children undergoing appendectomy at SCHN.
• To implement and evaluate a standardized care guideline for uncomplicated appendicitis.
• To assess the safety and efficacy of early discharge criteria.

Main Methods:

• A Clinical Redesign Methodology was employed.
• An Uncomplicated Appendicectomy Guideline was developed, including criteria for discharge after 6 hours post-operation.
• National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) data was used for analysis.

Main Results:

• Median postoperative LOS for uncomplicated appendicitis decreased from 24 to 16 hours (33% reduction, p < 0.001).
• No significant increase in readmissions or morbidity rates was observed.
• Increased emergency department presentations were noted post-discharge (p < 0.05).
• Parents reported being better informed, and staff noted increased autonomy.

Conclusions:

• Early discharge (from 6 hours post-operation) for pediatric uncomplicated appendicitis is safe.
• Comprehensive discharge information is crucial for successful early discharge.
• Standardized guidelines can effectively reduce LOS and improve patient/parent satisfaction.