Impact of outpatient management following appendectomy for acute appendicitis: An ACS NSQIP-P analysis

Cristen N. Litz, Laurie Stone, Roberta Alessi, Nebbie Walford, Paul D. Danielson, Nicole M. Chandler

Research output: Contribution to journalArticle

Abstract

Background: In 2012, a same-day discharge protocol following appendectomy for acute appendicitis was initiated. Our objective was to determine the success of the protocol by reviewing the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) outcomes following protocol development. Methods: The 2015 NSQIP-P Participant Use Data File was queried to identify patients with acute appendicitis who underwent appendectomy. Outcomes were compared to institutional outcomes. Results: There were 154 institutional patients and 4973 from NSQIP-P centers. Institutional rate of outpatient management was higher compared to NSQIP-P (84% vs 48%, p. <. 0.0001). Surgical length of stay was shorter compared to national rates (0.3. ±. 0.7 vs 1.1. ±. 1.9. days, p. <. 0.0001). There was no significant difference in the incidence of superficial (1.9% vs 1.0%, p = 0.2), deep (0.6% vs 0.1%, p = 0.17) or organ/space surgical site infections (1.3% vs 0.7%, p = 0.31). The incidences of other complications (1.3% vs 0.6%, p = 0.26) and 30-day readmissions (3.2% vs 2.6%, p = 0.61) were similar. Conclusion: Outpatient management following appendectomy in children is possible with low morbidity and readmission rates. Comparison with other NSQIP-Pediatric centers suggests an opportunity to generalize this practice with considerable savings to the health care system. Level of evidence: Prognosis study, level II.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jan 1 2017
Externally publishedYes

Fingerprint

Appendectomy
Appendicitis
Quality Improvement
Outpatients
Pediatrics
Surgical Wound Infection
Information Storage and Retrieval
Incidence
Length of Stay
Morbidity
Delivery of Health Care

Keywords

  • Laparoscopic appendectomy
  • NSQIP-p
  • Outpatient management
  • Pediatric
  • Same day discharge

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Impact of outpatient management following appendectomy for acute appendicitis : An ACS NSQIP-P analysis. / Litz, Cristen N.; Stone, Laurie; Alessi, Roberta; Walford, Nebbie; Danielson, Paul D.; Chandler, Nicole M.

In: Journal of Pediatric Surgery, 01.01.2017.

Research output: Contribution to journalArticle

Litz, Cristen N. ; Stone, Laurie ; Alessi, Roberta ; Walford, Nebbie ; Danielson, Paul D. ; Chandler, Nicole M. / Impact of outpatient management following appendectomy for acute appendicitis : An ACS NSQIP-P analysis. In: Journal of Pediatric Surgery. 2017.
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abstract = "Background: In 2012, a same-day discharge protocol following appendectomy for acute appendicitis was initiated. Our objective was to determine the success of the protocol by reviewing the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) outcomes following protocol development. Methods: The 2015 NSQIP-P Participant Use Data File was queried to identify patients with acute appendicitis who underwent appendectomy. Outcomes were compared to institutional outcomes. Results: There were 154 institutional patients and 4973 from NSQIP-P centers. Institutional rate of outpatient management was higher compared to NSQIP-P (84{\%} vs 48{\%}, p. <. 0.0001). Surgical length of stay was shorter compared to national rates (0.3. ±. 0.7 vs 1.1. ±. 1.9. days, p. <. 0.0001). There was no significant difference in the incidence of superficial (1.9{\%} vs 1.0{\%}, p = 0.2), deep (0.6{\%} vs 0.1{\%}, p = 0.17) or organ/space surgical site infections (1.3{\%} vs 0.7{\%}, p = 0.31). The incidences of other complications (1.3{\%} vs 0.6{\%}, p = 0.26) and 30-day readmissions (3.2{\%} vs 2.6{\%}, p = 0.61) were similar. Conclusion: Outpatient management following appendectomy in children is possible with low morbidity and readmission rates. Comparison with other NSQIP-Pediatric centers suggests an opportunity to generalize this practice with considerable savings to the health care system. Level of evidence: Prognosis study, level II.",
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