Appendectomy Options: Same Day Discharge Possible for Some

When 11-year old Ethan and his mom were sitting in the emergency room that early September morning they did not know what to expect. All they knew for sure was that Ethan was in pain.

After the doctor examined him, suspicions were high - there was a strong likelihood that Ethan could have appendicitis.

Acute appendicitis is the most common surgical emergency in children and adolescents. Overall, there are about 250,000 cases in the United States annually. The majority occur in children 6- to 10-years-old, and appendicitis affects boys slightly more often than girls.

“With the appropriate work-up we were able to move closer to confirming our suspicions,” said Rashmi Kabre, MD, pediatric surgeon at Ann & Robert H. Lurie Children’s Hospital of Chicago and assistant professor of surgery, Northwestern University Feinberg School of Medicine. “All indications were that it was most likely acute appendicitis.”

For patients suspected of having acute appendicitis, surgical removal of the appendix is still the most common treatment. Depending on several criteria, however, some patients may instead be candidates for a study involving intravenous antibiotic treatment only. In Ethan’s case, Dr. Kabre recommended surgery.

Laparoscopic surgery confirmed the appendicitis diagnosis, but also that his appendix was non-perforated, which was good news. If it had been perforated, his treatment plan would have been very different.

“If a patient, such as Ethan, has laparoscopic surgery, and it proves to be an uncomplicated case, that child may be a candidate to go home the same day,” said Dr. Kabre.

This, however, has not always been the case. For years the accepted practice has been to keep the patient in the hospital for several days. Now, though, published literature showcases the safety of allowing some patients to be discharged the same day and recover at home.

“Since we knew that same day discharge had been shown to be safe for patients, and since we also recognized that other hospitals were doing it successfully, we began piloting this program slowly over the last year,” said Julia Grabowski, MD, pediatric surgeon and assistant professor of surgery, Northwestern University Feinberg School of Medicine. “We have had great feedback from our patients and staff on this same day discharge option.”

Patients who qualify for same-day discharge must meet certain post-operative criteria:

• Have an uncomplicated case of appendicitis
• Be able to tolerate clear liquids
• Be afebrile

Have appropriate pain control with oral medications
“It is easier on the patient, as he is not disturbed every couple of hours in the hospital,” said Laurie Sands, APN, “and it is less upheaval and stress for the rest of the family too.”

“I just thought he would rest better at home,” said Suzanne Amaro, Ethan’s mother. “What I really loved is that there was no rush to make a decision to leave. The night nurse practitioner was so wonderful in letting us make the decision and not rushing us. Because Ethan got out of surgery after 5:00 pm, which was so late in the day, there was no way we could have anticipated how he would do that night. I couldn’t have asked for a better experience and outcome."