Factors that influence length of stay after appendicectomy in children

Background: The length of hospital stay following appendicectomy in childre n at Christchurch Hospital has decreased in recent years. The sim of the pr esent study was to identify those factors that contributed to this change. Methods: A retrospective review of children admitted to Christchurch Hospit al between 1994 and 1998 inclusive who underwent appendicectomy for suspect ed appendicitis was conducted. Data recorded included standard demographic information, symptom duration, operative details, analgesia, antibiotics, p athology, complications and postoperative length of stay (LOS). Results: Postoperative LOS decreased significantly during the period review ed across all degrees of appendiceal inflammation, from a mean of 70.5 to 5 0.1 h. The main determinant of postoperative hospital stay was the severity of the appendiceal inflammatory process. Other factors. that influenced LO S included surgical approach (open vs laparoscopic), use of intra-operative local anaesthesia, type and mode of postoperative analgesia, and age of th e child. Longer duration of antibiotic use and symptom duration of greater than 24 h were associated with a longer LOS, primarily as a reflection of t he severity of inflammation of the appendix. Factors that appeared to have little or no influence included gender and the experience of the surgeon. Conclusion: The severity of the inflammatory process appeared to be the mai n determinant of postoperative hospital LOS; advanced appendicitis with abs cess formation or peritonitis was associated with the longest LOS, irrespec tive of the surgical approach, although the LOS after appendicectomy was re duced by a laparoscopic approach. Intra-operative local anaesthesia during open appendicectomy reduced hospital stay, probably because it reduced the need for postoperative narcotics. Early diagnosis (< 24 h) was associated w ith a shorter postoperative LOS for acutely inflamed appendices.