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The following is a summary of “Implementation of a “Same Night” Appendectomy (SNAppy) Discharge Protocol: A Quality Improvement Initiative,” published in the January 2025 issue of Journal of Pediatric Surgery by Ramjist et al. 

Appendectomy remains the definitive treatment for appendicitis, and prolonged hospitalization is unnecessary for uncomplicated cases. To optimize post-operative care and expedite discharge, researchers implemented a structured protocol using multiple plan-do-study-act (PDSA) cycles. This protocol consists of three phases: pre-operative, intra-operative, and post-operative interventions. Pre-operatively, patient and caregiver expectations for early discharge are established with the administration of antibiotics and acetaminophen. Intra-operatively, measures include avoidance of a Foley catheter, administration of the maximum dose of local analgesic, routine skin prophylaxis, ondansetron, and ketorolac.

Post-operatively, discharge criteria include stable vital signs, adequate pain control, tolerance of liquids, and the ability to ambulate. The primary outcome was post-procedure length of stay, while counterbalance measures included unexpected ED visits and inpatient bed utilization. Statistical process control charts and Mann-Whitney U tests were used to quantify the impact of PDSA cycles, with significance defined as P < 0.05. Over a two-year period, 332 pediatric patients were analyzed, including 147 pre-protocol and 185 post-protocol. The median patient age was 9 years (IQR: 6-11), and the median procedure duration was 40 minutes (IQR: 29-53). Post-protocol implementation, median postoperative LOS was significantly reduced from 11.2 hours (IQR: 7.1-16.2) to 1.5 hours (IQR: 1.1-4.2) (P < 0.00001). 

Additionally, 68% of patients were discharged directly from the operating room post-implementation, compared to no pre-implementation. Rates of ED return did not significantly differ (6.8% pre-protocol vs. 9.2% post-protocol, P = 0.65), and there was no notable change in ED LOS (median 9:03 vs. 9:14, P = 0.48). These findings demonstrate that the SNAppy protocol effectively reduces post-operative LOS and inpatient bed utilization without increasing ED visits, supporting its role in enhancing efficiency in pediatric appendectomy management.

Source: jpedsurg.org/article/S0022-3468(25)00063-6/abstract