Same-Day Discharge for Paediatric Uncomplicated Appendicitis in Australia.

Background: Acute appendicitis is the most common paediatric emergency presentation requiring timely surgical intervention. The Sydney Children's Hospital Network (SCHN) noted in their National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) data that their appendicectomy postoperative length of stay (LOS) was longer than that of other hospitals.

Study design: NSQIP-P reports are calculated from case reviews with a 30-day post-operative follow-up. From 2020 to 2022, the post-operative LOS for uncomplicated appendicectomy at SCHN was a median of 24 h (n = 714). A quality improvement project was initiated using Clinical Redesign Methodology. The project team developed an Uncomplicated Appendicectomy Guideline to standardize care. The Guideline also included a criteria-led discharge that could be applied after 6 h of post-operative recovery. Comprehensive information was provided for parents/carers on discharge.

Results: In 2024, the median postoperative LOS was reduced from 24 to 16 h (n = 185). This represents a statistically significant reduction in post-operative length of stay of 33% (p < 0.001). There were no statistically significant increase in post-operative readmissions (p = 0.95) or in NSQIP-P morbidity rates, although there was an increase in post-operative Emergency Department presentations noted, from a median of 7-10 annual presentations (p < 0.05, n = 444). There was positive feedback from parents/carers with the earlier discharge (n = 16). Parents/carers who received the discharge information sheet reported that they were better informed about their child's care. Staff in focus groups highlighted a greater autonomy in post-operative care (n = 24).

Conclusion: Paediatric patients with uncomplicated appendicitis can be safely discharged from 6 h post-operatively with comprehensive discharge information.