Almost half of children with complicated appendicitis can recover from surgery at home

The research, led by Murdoch Children’s Research Institute (MCRI) and published in the Journal of Pediatric Surgery, found more than 40 per cent who received care in the home following a complex appendectomy recovered faster and had fewer complications.

More than 300 patients present with appendicitis to The Royal Children’s Hospital (RCH) every year, with about one in three experiencing a burst appendix or severe infection.

The study involved 83 children, aged five to 18 years, admitted to the RCH for a complicated appendicectomy, with 35 suitable for the Hospital in the Home (HITH) program. All patients needed at least five days of intravenous antibiotics (IV) post-surgery. Under the program, a nurse visited the child’s home daily to administer the antibiotics and record clinical observations.

MCRI Associate Professor Penelope Bryant said under this model, patients at home recovered more quickly and didn’t require readmission to hospital.

“Acute post-operative care at home is rare, but we found it’s possible for children to spend 35 per cent less time in hospital after complicated surgery,” she said. This could be done safely and without prolonging IV courses or broadening antibiotic use.

“These findings will help clinicians to identify which children are suitable for HITH care following surgery for complicated appendicitis.”

MCRI Associate Professor Warwick Teague said the HITH program, used heavily during the COVID-19 pandemic, had the added benefits of reduced hospital and family costs, improved quality of life, less time taken from work and prevention of hospital-acquired infections.

“The pandemic presented us with the need and opportunity to deliver care to children in their home,” he said. This study showed even children who had severe appendicitis can be well cared for at home after surgery, freeing up hospital beds for other sick children and those needing surgery.

“Traditionally after surgery for severe appendicitis, surgeons have insisted on daily reviews in hospital by the surgical team. However, in this study we learnt that optimal postoperative care be delivered at home, by well-trained non-surgical clinicians working as a team with surgeons.”

“For complicated appendicitis, the HITH program also saved over $1,400 per day for the hospital and $300 daily for families, reducing cost-of-living pressures with longer-term benefits for healthcare sustainability.”

Researchers from The Royal Children’s Hospital and University of Melbourne contributed to the study.