Use of expedited post-operative protocol for children undergoing appendicostomy reduces length of hospitalization.

Journal of Pediatric Surgery
Scott S ShortMichael D Rollins

Abstract

An appendicostomy (ACE) is a surgical option for antegrade enemas in children with severe constipation and/or fecal incontinence who have failed medical management.  In 2019, we initiated an expedited post-operative protocol and sought to examine our short-term outcomes compared with our historical cohort. A retrospective review was performed of all children undergoing ACE between 2017 and 2020. Children were excluded if they underwent an associated procedure (e.g. colon resection). Patients were divided into two cohorts: historical cohort (2017-2018, Group A) and the expedited protocol (2019 to present, Group B). The primary outcome was length of stay. 30 patients met inclusion (Group A = 16, Group B = 14). The most common indications for ACE were constipation (50%) and constipation or fecal incontinence associated with anorectal malformation (43%). Group B experienced a decreased length of stay (1 vs 3 days, P = 0.001) without differences in 30-day surgical site infection (7.1% vs 18.8%, p = 0.61) or unplanned visit (15.4% vs 18.8%, p = 1.0). Group B had a higher prevalence of MiniACE® button placed through the appendix vs. Malone (42.8% vs 12.5%, p = 0.10). Our expedited post-op protocol decreased length of stay without othe...Continue Reading

References

Dec 13, 1997·Journal of Pediatric Surgery·M A LevittA Peña
Oct 13, 2006·The American Journal of Gastroenterology·Maartje M van den BergC Di Lorenzo
Mar 4, 2011·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Taiwo A LawalMarc A Levitt
Apr 17, 2016·The Journal of Surgical Research·Julia K ShinnickMehul V Raval
Apr 27, 2019·Pediatric Surgery International·Mary E BrindleUNKNOWN on behalf Pediatric ERAS (Enhanced Recovery After Surgery) Society

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