Journal of Pediatric Surgery Open (Apr 2025)

Getting children home sooner on intravenous antibiotics with a Hospital-in-the-Home model of care for complicated appendicitis

  • Ling Chen,
  • Sebastian K. King,
  • Misel Trajanovska,
  • Lynda M. Gaynor,
  • Veronica Cerratti,
  • Rosemary Burgess,
  • Gregory J.G. Nolan,
  • Warwick J. Teague,
  • Penelope A. Bryant

DOI
https://doi.org/10.1016/j.yjpso.2025.100196
Journal volume & issue
Vol. 10
p. 100196

Abstract

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Children with complicated appendicitis requiring prolonged intravenous antibiotics could complete their treatment under Hospital-in-the-Home (HITH). Evidence is lacking in identifying suitable patients. Objective: To determine the feasibility of using post-operative clinical criteria in complicated appendicitis to identify eligible patients, and assess the safety of treating HITH-suitable patients at home. Methods: This was a prospective pilot study at a tertiary pediatric hospital. Children aged 5–18 years, undergoing appendicectomy, identified as having complicated appendicitis intra-operatively, with at least 5 days’ post-operative intravenous antibiotics planned. HITH suitable patients were defined clinically as tolerating diet and passing flatus before day 5. Interventions: The HITH model of care was developed and piloted. HITH-suitable patients were transferred and treated via HITH. Main Outcome Measures: Clinical characteristics and post-operative outcomes were measured and compared between patients treated in the hospital and patients treated at home. Results: During the model development 83 patients fulfilled inclusion criteria: 35 (42 %) HITH-suitable and 48 (58 %) HITH-unsuitable. The groups were similar pre-/peri‑operatively, but post-operatively HITH-suitable patients recovered faster (median length of stay 6 versus 7 days, p < 0.001) and had fewer complications (0 % vs 23 %, p = 0.001). Of the HITH-suitable group, initially 10 patients were treated on HITH and a further 15 during ongoing model assessment, totaling 25 (50 %) HITH-treated and 25 (50 %) HITH-suitable patients who remained in hospital. The HITH-treated patients spent 35 % less time in hospital, and had no increased rates of complications or re-admissions compared to suitable patients who remained in hospital. Conclusions: We have defined clinical criteria that identify children for whom HITH care appears safe following surgery for complicated appendicitis. Larger studies are required to validate these findings.

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