1. Use of expedited post-operative protocol for children undergoing appendicostomy reduces length of hospitalization
- Author
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Katherine Gaddis, Lija Mammen, Michael D. Rollins, Sarah Zobell, Elisabeth Wynne, and Scott S. Short
- Subjects
medicine.medical_specialty ,Constipation ,Length of hospitalization ,Enema ,Group B ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Colostomy ,medicine ,Humans ,Fecal incontinence ,Post operative ,Child ,Retrospective Studies ,Encopresis ,business.industry ,General Medicine ,Appendix ,Surgery ,Hospitalization ,Treatment Outcome ,medicine.anatomical_structure ,Associated procedure ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,medicine.symptom ,business ,Fecal Incontinence - Abstract
Background 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. Methods 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. Results 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). Conclusions Our expedited post-op protocol decreased length of stay without other significant adverse clinical sequelae. Level of evidence Retrospective Comparative Study, Level III.
- Published
- 2022