title: Impact of a 24-hour discharge pathway on outcomes of pediatric appendectomy.
abstract: 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.
authors: Center for Surgical Trials and Evidence-based Practice, University of Texas Medical School at Houston, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX.
authors: Luke R
authors: LR
authors: Putnam
authors: Center for Surgical Trials and Evidence-based Practice, University of Texas Medical School at Houston, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX.
authors: Shauna M
authors: SM
authors: Levy
authors: Children's Memorial Hermann Hospital, Houston, TX.
authors: Elizabeth
authors: E
authors: Johnson
authors: Children's Memorial Hermann Hospital, Houston, TX.
authors: Karen
authors: K
authors: Williams
authors: Children's Memorial Hermann Hospital, Houston, TX.
authors: Kimberlee
authors: K
authors: Taylor
authors: Center for Surgical Trials and Evidence-based Practice, University of Texas Medical School at Houston, Houston, TX; Department of Surgery, University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX.
authors: Lillian S
authors: LS
authors: Kao
authors: Center for Surgical Trials and Evidence-based Practice, University of Texas Medical School at Houston, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX.
authors: Kevin P
authors: KP
authors: Lally
authors: Center for Surgical Trials and Evidence-based Practice, University of Texas Medical School at Houston, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX. Electronic address: kuojen.tsao@uth.tmc.edu.
authors: KuoJen
authors: K
authors: Tsao
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects / Q000191:economics; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission; D011446:Prospective Studies; D013781:Texas; D016896:Treatment Outcome