Key result
Laparoscopic appendectomy and clinical pathway safely enable 24-hour discharge for ~66% of children with appendicitis.
Why the study?
The utility of laparoscopic appendectomy in children is controversial due to variable postoperative management, antibiotic duration, and discharge criteria.
Does laparoscopic appendectomy combined with an evidence-based clinical pathway allow for safe early discharge in children with appendicitis?
Cohort (n=72)
No
Does laparoscopic appendectomy combined with an evidence-based clinical pathway allow for safe early discharge in children with appendicitis?
p-value: p=<0.05
A commitment to laparoscopic appendectomy and an evidence-based clinical pathway enables safe discharge within 24 hours for the majority of children with acute appendicitis.
May support early discharge after laparoscopic appendectomy in select pediatric appendicitis cases; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: The utility of laparoscopic appendectomy (LA) in children remains controversial. The determination of the efficacy of LA in children is complicated by variable postoperative management, duration of antibiotics,and criteria for discharge. The aim of this study was to examine the results of a commitment to LA and the concurrent implementation of an evidence-based clinical pathway (CP) for management appendicitis in a children's hospital. METHODS: With institutional review board approval, all children presenting with appendicitis (n = 72; age =10.6 +/- 0.1 years) were offered LA and management directed by CP. Data were accrued prospectively for 12 consecutive months (May 2006 to April 2007) and analysis performed at 15 months. Data are reported as the mean +/- standard error of the mean. RESULTS: Children were stratified based on the operative findings: group one - acute 41; group two-suppurative=11; and group 3-gangrenous or perforated 20. Duration of hospital stay differed between the groups:group one= 26 +/- 0.3 hours; group 2 =48 +/- 3 hours; group 3= 127 +/- 6 hours (P <0.05). No patients in groups one or two suffered a complication or were readmitted following discharge. Two patients in group 3 (10%)were readmitted and treated with antibiotic therapy alone. Overall, 66% of the children with acute appendicitis(27/41) and 27% with suppurative appendicitis (3/11) were discharged within 24 hours of admission. Discharge by 24 hours in groups 1 and 2 was not influenced by age, gender, or time of operation (before or after 7 PM). CONCLUSIONS: The commitment to LA and use of CP resulted in discharge within 24 hours in 2 of 3 of children with acute appendicitis without readmission or complications being observed. Early discharge was not influenced by age, gender, or time of admission. For advanced appendicitis, length of hospital stay, determined by clinical parameters, resulted in a low rate of complication or readmission.
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Bensard et al. (2009) conducted a cohort in appendicitis (n=72). Laparoscopic appendectomy and clinical pathway was evaluated on Duration of hospital stay across appendicitis severity groups (p=<0.05). Laparoscopic appendectomy and an evidence-based clinical pathway enabled discharge within 24 hours for 66% of children with acute appendicitis, without complications or readmissions.
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