{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T21:01:20Z","timestamp":1781038880835,"version":"3.54.1"},"reference-count":36,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T00:00:00Z","timestamp":1621468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Complicated appendicitis encompasses a spectrum of severity with heterogeneity in definition and substantial variation in care. Enhanced recovery after surgery or \u2018fast\u2010track\u2019 protocols aim to reduce practice variation by standardizing care. These initiatives may improve quality and efficiency of care, preserve resources and expedite discharge. This study aims to evaluate the impact of a standardized Enhanced Recovery Pathway (ERP) on the post\u2010operative recovery of children with a subset of complicated appendicitis termed \u2018advanced\u2019 appendicitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We defined advanced appendicitis as gangrenous or suppurative appendicitis without perforation, contained iatrogenic perforation, or localized purulent fluid. Children with operative findings reflecting these criteria were enrolled in the ERP protocol. Key protocol components include early upgrade of diet, avoidance of intravenous analgesia, abridged intravenous antibiotics, early ambulation and standardized discharge criteria. The study period was May 2018 to June 2019. A historical cohort was used as the comparator group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Outcomes for 44 children treated under the ERP were compared to 44 historical controls. There was a 20% reduction in median post\u2010operative length of stay (1.80 vs. 2.24\u2009days, <jats:italic>p<\/jats:italic>\u00a0=\u20090.02). Intravenous analgesia was received by fewer patients (6.8% vs. 36.4%, <jats:italic>p<\/jats:italic>\u00a0=\u20090.01) with significant reduction in antiemetic requirement (<jats:italic>p<\/jats:italic>\u00a0=\u20090.03). No significant difference in 30\u2010day complication rates was observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Reduced post\u2010operative length of stay and reduction in practice variation were achieved after implementation of a \u2018fast\u2010track\u2019 protocol for children with advanced appendicitis. Additional benefits of this protocol include reduced provision of intravenous morphine analgesia, decreased resource use and cost savings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.16929","type":"journal-article","created":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T07:33:38Z","timestamp":1621496018000},"page":"1497-1503","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Improving quality and efficiency of care for advanced appendicitis in children"],"prefix":"10.1111","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8354-502X","authenticated-orcid":false,"given":"Montgommery","family":"Do\u2010Wyeld","sequence":"first","affiliation":[{"name":"Department of Paediatric Surgery Women's and Children's Hospital  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3884-2567","authenticated-orcid":false,"given":"Thomas 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