Effect of the enhanced recovery protocol in pediatric complicated appendicitis in a Peruvian hospital

Quispe-Gutiérrez D.; Aparicio-Ponce J.R.; Nolberto Sifuentes V.A.; Quispe A.M. · Anales de la Facultad de Medicina (2025) · DOI: 10.15381/anales.v86i1.28325

Resumen

Introduction: Enhanced recovery protocols have been successfully implemented across various surgical specialties to improve postoperative outcomes. However, little is known about their effect on the management of complicated pediatric appendicitis. Objective: To determine the effect of the Enhanced Recovery Protocol in Pediatric Surgery (PREMECIPE) on improving surgical outcomes, including length of hospital stay (LHS), complications, reoperations, and readmissions, in patients with complicated appendicitis at a public hospital in Lima, Peru, compared to the standard of care (SoC). Methods: We conducted a cohort study with a minimum follow-up period of 30 days. Twenty-seven patients with complicated appendicitis exposed to PREMECIPE were prospectively compared to a cohort of 48 patients exposed to SM. Outcomes of interest included LHS, complications, reoperations, and readmissions. Results: Compared to the SoC, PREMECIPE significantly reduced the postoperative stay (5.22 ± 2.41 vs. 6.45 ± 2.76 days, p<0.05) in patients with complicated appendicitis. PREMECIPE was associated with a significant reduction in LHS at crude analysis (incidence rate ratio = 0.81; 95% confidence interval: 0.67–0.99) and adjusted for the type of surgery (open vs. laparoscopic/ converted, 0.73; 95% confidence interval: 0.54–0.99). No significant benefits were observed regarding complications, reoperations, or readmissions. Conclusions: PREMECIPE, in children with complicated appendicitis, was associated with a reduction in postoperative stay of more than one day, regardless of the type of surgery without affecting the incidence of complications, reoperations, and readmissions.

Instituciones: Universidad Nacional Mayor de San Marcos; Universidad Señor de Sipán