Noninferiority of Implementing a Telephone Follow-Up Based Pathway After Uncomplicated Pediatric Appendectomy: A Retrospective Cohort Study
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Rayan A Rahmani1, Johanna M Borst2, Meredith E Osmulski2
1Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA; School of Education and Social Policy, Northwestern University, 2120 Campus Dr., Evanston, IL 60208, USA.
Introduction:
In-person postoperative follow-up after pediatric appendectomy imposes burdens without established clinical benefit over telemedicine follow-up. Telemedicine follow-up is safe after adult surgery and has high satisfaction after pediatric general surgery, but its safety after pediatric appendectomy has not been established. We evaluated whether implementation of a telephone-based follow-up pathway was noninferior to an in-person follow-up model for 30-day emergency department (ED) visits.
Methods:
We conducted a single-center retrospective cohort study of patients <18 years undergoing appendectomy for uncomplicated acute appendicitis between 2020 and 2025 using a Pediatric Health Information System query with manual chart review. On November 1, 2022, a telephone-based follow-up pathway was implemented. Pre- vs. post-implementation cohorts were compared. The primary outcome was a related ED visit within 30 days. Noninferiority was prespecified at an absolute margin of 3 percentage points using a one-sided 97.5% confidence interval (CI).
Results:
Among 1,570 patients (738 pre-, 832 post-implementation), receipt of telephone follow-up increased from 10.3% (n=76) to 65.7% (n=547) (p<0.001), and completion of any postoperative follow-up increased from 65.3% to 73.3% (p=0.002). Thirty-day related ED visits occurred in 32 (4.3%) patients pre-implementation and 28 (3.4%) post-implementation. The adjusted absolute risk difference was -1.03 percentage points (one-sided 97.5% CI, -∞ to +0.85), below the prespecified 3-percentage-point noninferiority margin.
Conclusions:
Implementation of a telephone-based follow-up pathway after uncomplicated pediatric appendectomy was noninferior for 30-day related ED visits, while improving overall follow-up completion and reducing the need for burdensome in-person visits.
