title: A dynamic postoperative protocol provides efficient care for pediatric patients with non-ruptured appendicitis.
abstract: OBJECTIVE
  Postoperative management of pediatric patients with non-ruptured appendicitis is highly variable and often includes an overnight stay in the hospital. We implemented a criteria-based postoperative protocol designed to eliminate postoperative antibiotics and facilitate timely discharge by utilizing the bedside nurse to evaluate for readiness for discharge.
  
  
  METHODS
  We collected data on all patients with non-ruptured appendicitis at our institution following protocol implementation (May 1, 2012 to April 30, 2013) and compared them to a control group.
  
  
  RESULTS
  580 patients were treated for non-ruptured appendicitis (285 prior protocol, 295 new protocol). Following implementation of our protocol, there was an overall reduction in length of stay from 40.1 (SD 27.5) to 23.5 (SD 20.8)h, and total cost of care per patient also decreased from $5783 (SD $2501) to $4499 (SD $1983) (p<0.001). There was no change in hospital readmission rate (1.1% prior protocol, 1.4% new protocol) or postoperative abscess rate (0.8% prior protocol, 0.3% new protocol).
  
  
  CONCLUSIONS
  Our new protocol reveals the value of eliminating postoperative antibiotics and leveraging the continuous availability of the bedside nurse in the determination of readiness for discharge.
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT. Electronic address: david.skarda@imail.org.
authors.forename: David E
authors.initials: DE
authors.lastname: Skarda
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Kathy
authors.initials: K
authors.lastname: Schall
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Michael
authors.initials: M
authors.lastname: Rollins
authors.affiliation: Systems Improvement Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Seth
authors.initials: S
authors.lastname: Andrews
authors.affiliation: Department of Pharmacology, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Jared
authors.initials: J
authors.lastname: Olson
authors.affiliation: University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT.
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.affiliation: University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT.
authors.forename: Molly
authors.initials: M
authors.lastname: McFadden
authors.affiliation: University of Utah School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Salt Lake City, UT.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Thorell
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Doug
authors.initials: D
authors.lastname: Barnhart
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Rebecka
authors.initials: R
authors.lastname: Meyers
authors.affiliation: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Eric
authors.initials: E
authors.lastname: Scaife
mesh_terms: D000293:Adolescent; D019072:Antibiotic Prophylaxis / Q000191:economics; D001062:Appendectomy / Q000191:economics*; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D002648:Child; D002985:Clinical Protocols; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D011184:Postoperative Period
keywords: Appendicitis; Cost; Length of stay; Non-ruptured; Pediatric; Protocol