D. Paone1, T. Tian1, A. Chernoguz1 1Tufts Medical Center,Surgery,Boston, MA, USA
Introduction: Laparoscopic appendectomy is a common pediatric surgical procedure. The surgery is generally well tolerated with low rates of peri-operative morbidity. Follow-up visits often require significant investment of time and travel expense for the patients’ families, but rarely identify post-operative complications. We hypothesized that a majority of postoperative complications are identified prior to the scheduled follow-up visit by telephone or electronic mail contact with the clinic and do not require a scheduled in-person visit.
Methods: A retrospective chart review of pediatric patients who underwent laparoscopic appendectomy at three affiliated academic medical centers over an 18-month period (1/1/2017-6/30/2018) was conducted after IRB approval. Demographic data and clinical findings pertaining to common post-surgical complications (wound and intra-abdominal infections, excessive pain) were analyzed. Patients with non-inflammatory pathology and interval appendectomies were excluded.
Results: A total of 164 charts were reviewed, of which 156 met inclusion criteria. Seventeen (10.9%) wound complications were identified. Only one of these was identified at the follow-up visit, while 94.1% (16/17) were identified via a communication initiated by the patient’s family before or after the visit. The majority of wound complications (70.6%) were managed without any additional follow-up. Ten patients reported pain (6.4%), but only three (30%) of them endorsed pain above the anticipated level. The patients with severe pain notified the clinic prior to the scheduled visit. Overall, the in-person follow-up failure rate was 11.5%, including 5% who contacted the clinic with questions despite missing the scheduled visit.
Conclusion: Laparoscopic appendectomy is a well-tolerated procedure in children with low rates of complications. In this study, 10.9% and 6.4% of patients experienced wound or pain complications, respectively. Overall, 137 of the 138 (99.2%) in-person visits did not contribute to identification of a clinically meaningful postoperative complication. Based on these results, routine post-operative follow-up after laparoscopic appendectomy may not be necessary and can be substituted by telephone or electronic mail contact with the clinic. A prospective trial evaluating the parental satisfaction, time and financial savings, as well as the ability to evaluate wounds using photographic follow-up is necessary.
