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An Enhanced Recovery Protocol that Facilitates Same-day Discharge for Simple Laparoscopic Appendectomies

Acute appendicitis is the most common gastrointestinal condition requiring urgent operation in the pediatric population with laparoscopic appendectomy (LA) being the current surgical technique. We describe the implementation of a standardized protocol to reduce postoperative nausea and vomiting (PON...

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Autores principales: Shafy, Shabana Z., Miller, Rebecca, Uffman, Joshsua C., Tobias, Joseph D., Fetzer, Mike, Nordin, Andrew B., Kenney, Brian, Walia, Hina, Veneziano, Giorgio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946221/
https://www.ncbi.nlm.nih.gov/pubmed/32010869
http://dx.doi.org/10.1097/pq9.0000000000000243
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author Shafy, Shabana Z.
Miller, Rebecca
Uffman, Joshsua C.
Tobias, Joseph D.
Fetzer, Mike
Nordin, Andrew B.
Kenney, Brian
Walia, Hina
Veneziano, Giorgio
author_facet Shafy, Shabana Z.
Miller, Rebecca
Uffman, Joshsua C.
Tobias, Joseph D.
Fetzer, Mike
Nordin, Andrew B.
Kenney, Brian
Walia, Hina
Veneziano, Giorgio
author_sort Shafy, Shabana Z.
collection PubMed
description Acute appendicitis is the most common gastrointestinal condition requiring urgent operation in the pediatric population with laparoscopic appendectomy (LA) being the current surgical technique. We describe the implementation of a standardized protocol to reduce postoperative nausea and vomiting (PONV) and facilitate same-day discharge after LA. METHODS: A multidisciplinary team developed this protocol to facilitate same-day discharge after observing high rates of overnight stay due to PONV among simple appendectomies performed in 2011–2012. The protocol was implemented in November 2014 and underwent a revision in June 2016. Following the implementation of the protocol, we monitored the patients undergoing an LA at Nationwide Children’s Hospital between November 2014 and August 2017. RESULTS: We identified 691 patients (255 female) who underwent a simple LA at Nationwide Children’s Hospital between November 2014 and August 2017. The patient population had a median age of 11 years (interquartile range: 9, 14). Among these patients, 514 (74%) were discharged on the day of surgery, and 387 (56%) were protocol compliant. The rate of same-day discharge was higher for compliant cases (79%) than noncompliant cases (69%, P = 0.003). Multivariable statistical analysis associated compliance with an increased likelihood of same-day discharge (Odds ratio [OR] = 1.7, 95% CI: 1.2, 2.4, P = 0.002). CONCLUSIONS: Implementation of the LA protocol to reduce PONV demonstrated a significant increase in the rate of same-day discharge from the hospital among compliant patients. Also, the adoption of a protocol to select patients for early discharge after LA has shown results with a 45% reduction in the need for inhospital beds.
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spelling pubmed-69462212020-01-31 An Enhanced Recovery Protocol that Facilitates Same-day Discharge for Simple Laparoscopic Appendectomies Shafy, Shabana Z. Miller, Rebecca Uffman, Joshsua C. Tobias, Joseph D. Fetzer, Mike Nordin, Andrew B. Kenney, Brian Walia, Hina Veneziano, Giorgio Pediatr Qual Saf Individual QI Projects from Single Institutions Acute appendicitis is the most common gastrointestinal condition requiring urgent operation in the pediatric population with laparoscopic appendectomy (LA) being the current surgical technique. We describe the implementation of a standardized protocol to reduce postoperative nausea and vomiting (PONV) and facilitate same-day discharge after LA. METHODS: A multidisciplinary team developed this protocol to facilitate same-day discharge after observing high rates of overnight stay due to PONV among simple appendectomies performed in 2011–2012. The protocol was implemented in November 2014 and underwent a revision in June 2016. Following the implementation of the protocol, we monitored the patients undergoing an LA at Nationwide Children’s Hospital between November 2014 and August 2017. RESULTS: We identified 691 patients (255 female) who underwent a simple LA at Nationwide Children’s Hospital between November 2014 and August 2017. The patient population had a median age of 11 years (interquartile range: 9, 14). Among these patients, 514 (74%) were discharged on the day of surgery, and 387 (56%) were protocol compliant. The rate of same-day discharge was higher for compliant cases (79%) than noncompliant cases (69%, P = 0.003). Multivariable statistical analysis associated compliance with an increased likelihood of same-day discharge (Odds ratio [OR] = 1.7, 95% CI: 1.2, 2.4, P = 0.002). CONCLUSIONS: Implementation of the LA protocol to reduce PONV demonstrated a significant increase in the rate of same-day discharge from the hospital among compliant patients. Also, the adoption of a protocol to select patients for early discharge after LA has shown results with a 45% reduction in the need for inhospital beds. Wolters Kluwer Health 2019-12-05 /pmc/articles/PMC6946221/ /pubmed/32010869 http://dx.doi.org/10.1097/pq9.0000000000000243 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Individual QI Projects from Single Institutions
Shafy, Shabana Z.
Miller, Rebecca
Uffman, Joshsua C.
Tobias, Joseph D.
Fetzer, Mike
Nordin, Andrew B.
Kenney, Brian
Walia, Hina
Veneziano, Giorgio
An Enhanced Recovery Protocol that Facilitates Same-day Discharge for Simple Laparoscopic Appendectomies
title An Enhanced Recovery Protocol that Facilitates Same-day Discharge for Simple Laparoscopic Appendectomies
title_full An Enhanced Recovery Protocol that Facilitates Same-day Discharge for Simple Laparoscopic Appendectomies
title_fullStr An Enhanced Recovery Protocol that Facilitates Same-day Discharge for Simple Laparoscopic Appendectomies
title_full_unstemmed An Enhanced Recovery Protocol that Facilitates Same-day Discharge for Simple Laparoscopic Appendectomies
title_short An Enhanced Recovery Protocol that Facilitates Same-day Discharge for Simple Laparoscopic Appendectomies
title_sort enhanced recovery protocol that facilitates same-day discharge for simple laparoscopic appendectomies
topic Individual QI Projects from Single Institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946221/
https://www.ncbi.nlm.nih.gov/pubmed/32010869
http://dx.doi.org/10.1097/pq9.0000000000000243
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