Impact of a 24-hour discharge pathway on outcomes of pediatric appendectomy.

Background: Clinical pathways for simple (nonperforated, nongangrenous) appendicitis potentially could decrease hospital length of stay (LOS) through standardization of patient care. Our institution initiated a simple appendicitis pathway for children with the goal of less than 24-hour discharge (same-day discharge, SDD) and evaluated its effectiveness.

Methods: A prospective cohort of pediatric patients (<18 years of age) who underwent appendectomy for simple appendicitis after implementation of a SDD pathway were compared with a historic cohort of similar patients in this same large children's hospital. Primary outcomes included LOS, surgical-site infections, and readmissions. Mann Whitney U test, Fischer exact test, χ(2) test, and logistic regression were used.

Results: Between June 2009 and May 2013, 1,382 appendectomies were performed; 794 (57%) were for simple appendicitis (316 prepathway and 478 pathway). Hospital LOS decreased 37% after pathway implementation from a median (interquartile range) of 35 (20-50) hours to 22 (9-55) hours (P < .001). SDD increased from 13% to 58% (P < .001). Infectious complications were unchanged (1.6% vs 1.8%, P = .82), but readmissions increased (1.2% vs 4.2%, P = .02).

Conclusions: A standardized pathway for simple appendicitis that targets SDD can be achieved in children; however, a slight increase in readmissions was noted. High risk for readmission, cost effectiveness, and generalizability need to be further determined.