Home recovery after surgery for complicated appendicitis feasible for some children

Around 40 percent of children who have undergone a surgical procedure for complicated appendicitis can be safely sent home for recovery, as shown in a pilot study.

The study was conducted at a tertiary paediatric hospital and included children who were between 5 and 18 years of age, undergoing appendicectomy, identified as having complicated appendicitis intraoperatively, and had at least 5 days’ postoperative intravenous antibiotics planned. Researchers determined the feasibility of using postoperative clinical criteria in complicated appendicitis to identify eligible patients for Hospital-in-the-Home (HITH) care and assess its safety.

HITH was a model of care wherein intravenous (IV) antibiotics could be safely delivered at home acutely after appendicectomy without prolonging IV courses or broadening antibiotics. The postoperative criteria within the eligible population for determining inclusion for HITH-suitability were: 1) passed flatus or stool by day 4 or earlier, 2) tolerating light diet (ingestion of some solid food without vomiting and not returned to fluid diet) by day 4 or earlier, and 3) IV antibiotics as the only ongoing intervention (eg, not requiring IV pain management).

During the HITH model development, 83 patients met the inclusion criteria. Of these, 35 (42 percent) were HITH-suitable and 48 (58 percent) were not. Patient characteristics were similar between the two groups pre- and perioperatively. Postoperatively, however, HITH-suitable patients had significantly faster recovery (median length of hospital stay, 6 vs 7 days; p<0.001) and fewer complications (0 percent vs 23 percent; p=0.001).

In the HITH-suitable group, initially, 10 patients were treated on HITH and a further 15 during ongoing model assessment, for a total of 25 (50 percent) HITH-treated patients and 25 (50 percent) HITH-suitable patients who remained in hospital. Compared with the HITH-suitable patients who remained in hospital, HITH-treated patients spent 35-percent less time in hospital without increased rates of complications or readmissions.