Ling Chen , Sebastian K. King , Misel Trajanovska , Lynda M. Gaynor , Veronica Cerratti , Rosemary Burgess , Gregory J.G. Nolan , Warwick J. Teague , Penelope A. Bryant
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Children aged 5–18 years, undergoing appendicectomy, identified as having complicated appendicitis intra-operatively, with at least 5 days’ post-operative intravenous antibiotics planned. HITH suitable patients were defined clinically as tolerating diet and passing flatus before day 5.</div></div><div><h3>Interventions</h3><div>The HITH model of care was developed and piloted. HITH-suitable patients were transferred and treated via HITH.</div></div><div><h3>Main Outcome Measures</h3><div>Clinical characteristics and post-operative outcomes were measured and compared between patients treated in the hospital and patients treated at home.</div></div><div><h3>Results</h3><div>During the model development 83 patients fulfilled inclusion criteria: 35 (42 %) HITH-suitable and 48 (58 %) HITH-unsuitable. The groups were similar pre-/peri‑operatively, but post-operatively HITH-suitable patients recovered faster (median length of stay 6 versus 7 days, <em>p</em> < 0.001) and had fewer complications (0 % vs 23 %, <em>p</em> = 0.001). Of the HITH-suitable group, initially 10 patients were treated on HITH and a further 15 during ongoing model assessment, totaling 25 (50 %) HITH-treated and 25 (50 %) HITH-suitable patients who remained in hospital. The HITH-treated patients spent 35 % less time in hospital, and had no increased rates of complications or re-admissions compared to suitable patients who remained in hospital.</div></div><div><h3>Conclusions</h3><div>We have defined clinical criteria that identify children for whom HITH care appears safe following surgery for complicated appendicitis. Larger studies are required to validate these findings.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100196"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Getting children home sooner on intravenous antibiotics with a Hospital-in-the-Home model of care for complicated appendicitis\",\"authors\":\"Ling Chen , Sebastian K. King , Misel Trajanovska , Lynda M. Gaynor , Veronica Cerratti , Rosemary Burgess , Gregory J.G. Nolan , Warwick J. Teague , Penelope A. Bryant\",\"doi\":\"10.1016/j.yjpso.2025.100196\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div>Children with complicated appendicitis requiring prolonged intravenous antibiotics could complete their treatment under Hospital-in-the-Home (HITH). Evidence is lacking in identifying suitable patients.</div></div><div><h3>Objective</h3><div>To determine the feasibility of using post-operative clinical criteria in complicated appendicitis to identify eligible patients, and assess the safety of treating HITH-suitable patients at home.</div></div><div><h3>Methods</h3><div>This was a prospective pilot study at a tertiary pediatric hospital. Children aged 5–18 years, undergoing appendicectomy, identified as having complicated appendicitis intra-operatively, with at least 5 days’ post-operative intravenous antibiotics planned. HITH suitable patients were defined clinically as tolerating diet and passing flatus before day 5.</div></div><div><h3>Interventions</h3><div>The HITH model of care was developed and piloted. HITH-suitable patients were transferred and treated via HITH.</div></div><div><h3>Main Outcome Measures</h3><div>Clinical characteristics and post-operative outcomes were measured and compared between patients treated in the hospital and patients treated at home.</div></div><div><h3>Results</h3><div>During the model development 83 patients fulfilled inclusion criteria: 35 (42 %) HITH-suitable and 48 (58 %) HITH-unsuitable. The groups were similar pre-/peri‑operatively, but post-operatively HITH-suitable patients recovered faster (median length of stay 6 versus 7 days, <em>p</em> < 0.001) and had fewer complications (0 % vs 23 %, <em>p</em> = 0.001). Of the HITH-suitable group, initially 10 patients were treated on HITH and a further 15 during ongoing model assessment, totaling 25 (50 %) HITH-treated and 25 (50 %) HITH-suitable patients who remained in hospital. 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引用次数: 0
摘要
需要长时间静脉注射抗生素的复杂阑尾炎儿童可以在家庭医院（HITH）下完成治疗。在确定合适的患者方面缺乏证据。目的探讨在复杂阑尾炎中应用术后临床标准筛选符合条件的患者的可行性，并评价在家治疗适合hith患者的安全性。方法在某三级儿科医院进行前瞻性先导研究。5 - 18岁儿童，行阑尾切除术，术中确诊为复杂阑尾炎，术后至少5天静脉注射抗生素。HITH适宜患者临床定义为饮食耐受且第5天前排气。干预措施HITH的护理模式得到了发展和试点。适合hth的患者通过hth转移和治疗。主要结果测量测量在医院治疗的患者和在家治疗的患者的临床特征和术后结果并进行比较。结果在模型开发过程中，83例患者符合纳入标准：35例（42%）适合hith， 48例（58%）不适合hith。两组术前/围手术期相似，但术后适合hith的患者恢复更快(中位住院时间6天对7天，p <；0.001)，并发症较少（0% vs 23%, p = 0.001）。在适合hth的组中，最初有10名患者接受了hth治疗，另外15名患者正在进行模型评估，总共有25名（50%）接受了hth治疗，25名（50%）适合hth的患者仍在住院。与适合住院的患者相比，接受hith治疗的患者住院时间减少了35%，并发症或再入院率没有增加。结论：我们已经确定了临床标准，以确定在复杂阑尾炎手术后进行hth治疗的儿童是安全的。需要更大规模的研究来验证这些发现。
Getting children home sooner on intravenous antibiotics with a Hospital-in-the-Home model of care for complicated appendicitis
Children with complicated appendicitis requiring prolonged intravenous antibiotics could complete their treatment under Hospital-in-the-Home (HITH). Evidence is lacking in identifying suitable patients.
Objective
To determine the feasibility of using post-operative clinical criteria in complicated appendicitis to identify eligible patients, and assess the safety of treating HITH-suitable patients at home.
Methods
This was a prospective pilot study at a tertiary pediatric hospital. Children aged 5–18 years, undergoing appendicectomy, identified as having complicated appendicitis intra-operatively, with at least 5 days’ post-operative intravenous antibiotics planned. HITH suitable patients were defined clinically as tolerating diet and passing flatus before day 5.
Interventions
The HITH model of care was developed and piloted. HITH-suitable patients were transferred and treated via HITH.
Main Outcome Measures
Clinical characteristics and post-operative outcomes were measured and compared between patients treated in the hospital and patients treated at home.
Results
During the model development 83 patients fulfilled inclusion criteria: 35 (42 %) HITH-suitable and 48 (58 %) HITH-unsuitable. The groups were similar pre-/peri‑operatively, but post-operatively HITH-suitable patients recovered faster (median length of stay 6 versus 7 days, p < 0.001) and had fewer complications (0 % vs 23 %, p = 0.001). Of the HITH-suitable group, initially 10 patients were treated on HITH and a further 15 during ongoing model assessment, totaling 25 (50 %) HITH-treated and 25 (50 %) HITH-suitable patients who remained in hospital. The HITH-treated patients spent 35 % less time in hospital, and had no increased rates of complications or re-admissions compared to suitable patients who remained in hospital.
Conclusions
We have defined clinical criteria that identify children for whom HITH care appears safe following surgery for complicated appendicitis. Larger studies are required to validate these findings.
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