Appendicitis: Symptoms, Surgery and the Benefits of Same-Day Discharge
Appendectomy (removal of the appendix) is one of the most common emergent surgeries in children. More than 400 appendectomies are performed at Children’s Mercy each year, and of those patients, nearly 90 percent of those without rupture are discharged within four hours of surgery to recover comfortably at home.
We asked Dr. Tolulope Oyetunji, Director of Health Outcomes Research in the Department of Surgery, to discuss the symptoms of appendicitis and the benefits of same-day discharge.
What is appendicitis?
Dr. Oyetunji: Appendicitis is the inflammation and infection of the appendix, which can cause severe abdominal pain. One in 15 people will get appendicitis during their lifetime, and it’s most common in children and teens, usually between 8 and 20 years of age.
There’s really nothing that can be done to prevent appendicitis from happening based on our current understanding. However, early diagnosis and treatment are key, because if left untreated the appendix can rupture and cause your child to become extremely ill.
What are the symptoms of appendicitis?
Dr. Oyetunji: Every child experiences abdominal pain from time-to-time, but appendicitis has distinct symptoms that go beyond the run-of-the-mill stomachache.
While appendicitis is rare for children under the age of two, the symptoms for infants and toddlers include: fussiness, inconsolability, a distended abdomen and vomiting.
In older children, symptoms include: mild fever, significant pain in the lower abdomen (typically near the belly button initially that starts intermittently and then becomes constant usually on the right lower side of the abdomen), lack of appetite, nausea, vomiting and diarrhea (usually minimal).
If your child shows symptoms of appendicitis you should contact your pediatrician immediately.
How is appendicitis treated?
Dr. Oyetunji: The standard procedure for care is laparoscopic surgery, which is minimally invasive, when the appendix is not ruptured. At Children’s Mercy, we can still complete the procedure this way even if ruptured. Nearly 90 percent of our patients go home within four hours of surgery if there is no rupture.
What is the advantage of going home the same day as surgery?
Dr. Oyetunji: There are several benefits. First, these are normally healthy children, so getting patients out of the hospital sooner reduces their risks of being around sicker patients.
Second, and the most important benefit according to feedback we have received, is convenience. An appendectomy isn’t a procedure parents can plan for in advance since it’s an emergent situation, and being in the hospital for several days can be a huge disruption for the entire family. In the past, a patient would be in the hospital for two to four days. Now, patients have the option of going home just hours after surgery if the appendix is not ruptured. Children recover better when they’re at home in a more familiar environment, and can sleep in their own beds. It also reduces the number of days kids miss school and parents miss work.
How common is same-day discharge for non-perforated appendectomies?
Dr. Oyetunji: It’s not as common as one would think. Many children treated in adult hospitals and even at some children’s hospitals will be required to stay an additional day or longer after surgery.
From our research we’ve created an evidence-based protocol to offer same-day discharge when possible, because the evidence-based research show it’s not associated with worse outcomes. When we first started offering same-day discharge in 2012 for non-ruptured appendicitis, only 28 percent of patient were going home the same day as surgery. Now that number is up 87 percent. Same-day discharge is a priority for the surgeons, nurses and anesthesiologists, and it’s become part of the culture at this hospital.
Patients can go home as soon as the pain is well-controlled, and resume normal eating habits and activities as soon as they leave the hospital. There are no restrictions.
Why would a child need to stay the night after surgery?
Dr. Oyetunji: While most children go home same day, there are some patients that need to stay the night if surgery ends late or if they have pain, nausea or other medical comorbidities. Some parents prefer their child stays in the hospital overnight and that’s ok too. The bottom line is we want what’s best for the patient and what is most convenient for the family.
Learn more about Appendicitis Surgery at Children’s Mercy.