Use of Expedited Post-Operative Protocol for Children Undergoing Appendicostomy Reduces Length of Hospitalization
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In brief
In brief
Retrospective study of 30 pediatric patients demonstrates that an expedited post-operative protocol for appendicostomy (ACE) procedures significantly reduced hospital length of stay from 3 days to 1 day without increasing surgical site infections or unplanned visits. Protocol particularly effective for children with severe constipation and fecal incontinence who failed medical management.
Written by the GCMD Library team from the article.
Abstract
Background
An appendicostomy (ACE) is a surgical option for antegrade enemas in children with severe constipation and/or fecal incontinence who have failed medical management. In 2019, we initiated an expedited post-operative protocol and sought to examine our short-term outcomes compared with our historical cohort.
Methods
A retrospective review was performed of all children undergoing ACE between 2017 and 2020. Children were excluded if they underwent an associated procedure (e.g. colon resection). Patients were divided into two cohorts: historical cohort (2017-2018, Group A) and the expedited protocol (2019 to present, Group B). The primary outcome was length of stay.
Results
30 patients met inclusion (Group A=16, Group B = 14). The most common indications for ACE were constipation (50%) and constipation or fecal incontinence associated with anorectal malformation (43%). Group B experienced a decreased length of stay (1 vs 3 days, P = 0.001) without differences in 30-day surgical site infection (7.1% vs 18.8%, p = 0.61) or unplanned visit (15.4% vs 18.8%, p=1.0). Group B had a higher prevalence of MiniACE® button placed through the appendix vs. Malone (42.8% vs 12.5%, p=0.10).
Conclusions
Our expedited post-op protocol decreased length of stay without other significant adverse clinical sequelae.