Use of expedited post-operative protocol for children undergoing appendicostomy reduces length of hospitalization | 30 patients | 16 pt - Historical cohort (Group A) | 14 pt - Expedited (Group B) | 4 years | Retrospective review of all children underwent appendicostomy (ACE) at a single institute | Most common indications for ACE | Constipation | 50% | Constipation or fecal incontinence associated w/ anorectal malformation | 45% | Group B experienced decreased length of stay (1 vs 3 days) (p=0.001) | higher prevalence of MiniACE®button placed (42.8% vs 12.5%) | through the appendix vs. Malone (p = 0.10) | Conclusion: Expedited post-op protocol decreased length of stay without other significant adverse clinical sequelae. | https://pubmed.ncbi.nlm.nih.gov/33962760/ | @EmTombash | Source: Short SS et al. Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, United States | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Use of expedited post-operative protocol for children undergoing appendicostomy reduces length of hospitalization
Infographic · May 2022 · 1 min read
In brief
In brief
Implementation of an expedited post-operative protocol for pediatric appendicostomy (ACE) procedures reduced hospital length of stay from 3 days to 1 day without increasing surgical site infections or unplanned visits. The protocol was applied to children with severe constipation and fecal incontinence, demonstrating safe early discharge is feasible for this population.
- Expedited post-op protocol reduced hospital stay from 3 days to 1 day after appendicostomy without increasing complications
- No significant difference in 30-day surgical site infections (7.1% vs 18.8%) or unplanned visits between expedited and standard protocols
- MiniACE button placement may facilitate earlier discharge compared to traditional Malone appendicostomy technique
- Early discharge protocol is safe for pediatric patients with constipation or fecal incontinence after isolated appendicostomy procedures
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with cartoon illustrations of four diverse children and a surgeon. It's divided into sections with a calendar icon on the left, patient cohort information at top, indication percentages in the middle, and results with conclusion in a yellow box at bottom right. Icons and simple graphics support each data point.
Scott S Short, Sarah Zobell, Katherine Gaddis, Lija Mammen, Elisabeth Wynne, Michael D Rollins
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.