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Purpose Many pediatric patients are initially diagnosed with appendicitis at referring hospitals and are subsequently transferred to pediatric facilities. We aimed to compare outcomes of patients transferred to a pediatric referral center to those who present primarily for operative management of appendicitis. Methods: A retrospective review of 326 patients with operative appendicitis from July 2012 to July 2013 was performed. Demographic data, clinical parameters, and outcomes were analyzed. Results: Transferred ( n = 222, 68%) and primary patients ( n = 104, 32%) were similar except for mean age (primary 12.4 vs. transferred 11.2 years, p < 0.01). Computed tomography scans were performed in 80% of transferred compared to 40% of primary patients. Primary patients were more likely to present between the hours of 09:00 and 17:59 (52%), while transferred arrived equally across all hours. Both groups were more likely to present with acute appendicitis (primary 56% vs. transfer 61%, p = NS). There was no difference in time of diagnosis to time of appendectomy, length of hospital stay, or 30 day complications (primary 8.6% vs. transfer 5.8%, p = NS). Conclusions: Patients transferred for definitive care of appendicitis are not found to have more advanced disease or have increased complications; however, they are exposed to significantly more ionizing radiation during evaluation for appendicitis. [ABSTRACT FROM AUTHOR]

Appendectomy incurs significant costs for the healthcare system. There is evidence that patients can be safely discharged the same day after appendectomy. The purpose of this study was to develop an evidence-based protocol for same-day discharge after appendectomy. A fast-track surgery protocol was developed for same-day discharge after appendectomy. This was prospectively applied to all patients presenting for appendectomy from July 2012 to June 2013. Demographics, clinical measures, and outcomes were measured. Of 206 patients eligible for same- day discharge, 185 (90%) were successfully discharged according to the protocol. The mean length of stay after appendectomy was 3.1 ± 1.4 hours. Protocol implementation reduced inpatient use from 99 to 53 per cent. Patient transfers were reduced, resulting in 40 per cent fewer handoffs. The decreased use of hospital resources resulted in a median reduction of hospital charges of $4111 per patient. The complication rate for patients discharged the same day was 2.7 per cent. Appendectomy for acute appendicitis or interval appendectomy can be performed safely as same-day surgery. Implementation of this protocol resulted in optimization of resource use by reducing inpatient admissions, decreasing handoffs, and reducing hospital costs. [ABSTRACT FROM AUTHOR]

Purpose: Post-operative management following appendectomy is dependent upon intraoperative assessment. We determined concordance between surgical and histopathologic diagnosis to better predict resource utilization in pediatric patients undergoing appendectomy., Methods: A retrospective analysis of 326 patients with operative appendicitis from July 2012 to July 2013 was performed. Based on operative findings, patients were classified as simple appendicitis (SA) or complex appendicitis (CA)., Results: The SA group included 194 (59.5%) patients while the CA group included 132 (40.5%) patients. There were significant differences in WBC, CRP, operative time, length of stay, and 30-day complications. Seventy percent of patients with intra-operative findings of SA were found to have complex pathology while 10.6% with intra-operative findings of CA were found to have simple pathology. There is poor agreement between intra-operative findings and histopathologic findings (κ=0.173). Although 70% of patients with intra-operative findings of SA were labeled as complex pathology, 86% followed a fast track protocol (same day discharge) with a low complication rate (1.7%)., Conclusions: Pathology findings that overestimate the severity of disease correlate poorly with the post-operative outcomes for appendicitis. We conclude that operative findings are more predictive of clinical course than histopathologic results. This can have an impact on resource utilization planning., (Copyright © 2015 Elsevier Inc. All rights reserved.)