Novel Quality Improvement Targets to Address Healthcare Encounters After Pediatric Appendectomy

Azraa S. Chaudhury, Andrew Hu*, Radhika Mathur, Maxwell McMahon, Martha Conley Ingram, Abbey Studer, Seth D. Goldstein, Mehul V. Raval

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Pediatric appendicitis clinical practice guidelines (CPGs) do not typically address postdischarge healthcare encounters. This study aims to examine common indications for returns to the health system to identify novel quality improvement targets. Methods: This retrospective cohort study analyzed patients aged 3 to 18 y undergoing appendectomy at a single institution from July 1, 2019, to July 31, 2020. The primary outcome was physical postdischarge encounters comprising emergency department (ED) visits and hospital readmissions. Indications for each encounter were categorized and stratified by appendicitis type (i.e., simple, gangrenous, or perforated). Multivariable logistic regression models were used to estimate association between appendicitis category and postdischarge encounters. Results: Of 434 patients, 240 (55.3%) had simple appendicitis, 77 (17.7%) gangrenous, and 117 (29.9%) perforated appendicitis. Overall, 48 patients had at least one instance of an unplanned postdischarge encounter with a total of 56 unplanned ED presentations and 24 readmissions. Perforated patients were significantly more likely to experience postdischarge ED (odds ratio 2.55; 95% confidence interval 1.29-5.02) and readmission encounters (odds ratio 6.63; 95% confidence interval 2.28-19.28). Common indications for ED encounters included abdominal pain (n = 20) with 25.0% readmitted, abdominal pain and gastrointestinal symptoms (e.g., diarrhea, vomiting, distention) (n = 16) with 87.5% readmitted, and incision concerns (n = 6) with 16.7% readmitted. Common indications for readmissions included intraabdominal abscesses (n = 8) and small bowel obstruction (n = 4). Conclusions: Assessing indications for postdischarge healthcare encounters enables identification of novel quality improvement targets, including proactively addressing incision concerns and abdominal pain.

Original languageEnglish (US)
Pages (from-to)511-517
Number of pages7
JournalJournal of Surgical Research
Volume279
DOIs
StatePublished - Nov 2022

Keywords

  • Clinical practice guideline
  • ED encounter
  • Pediatric appendicitis
  • Post-discharge healthcare encounter
  • Quality improvement
  • Readmission

ASJC Scopus subject areas

  • Surgery

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