Noninferiority of Implementing a Telephone Follow-Up Based Pathway After Uncomplicated Pediatric Appendectomy: A Retrospective Cohort Study
In brief
Telephone follow-up was noninferior, with 3.4% returning to emergency care
In this single-center study, related 30-day emergency visits occurred in 3.4% of children after the telephone pathway was introduced, versus 4.3% before; the difference met the prespecified standard for noninferiority. Telephone follow-up rose to 65.7%, and overall follow-up completion improved, but the retrospective design and single-center setting limit how widely the results can be applied.
- Journal
- Journal of pediatric surgery (Q1)
- Published
- 29 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Rayan A Rahmani, Johanna M Borst, Meredith E Osmulski, Micah Holloway, Meraris Acosta, Timothy B Lautz, et al.
- PMID
- 42956885
- DOI
- 10.1016/j.jpedsurg.2026.163569
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 31 October 2026): Noninferiority study of follow-up after pediatric appendectomy
Abstract
INTRODUCTION: In-person postoperative follow-up after pediatric appendectomy imposes burdens without established clinical benefit over telemedicine follow-up. Telemedicine follow-up is safe after adult surgery and has high satisfaction after pediatric general surgery, but its safety after pediatric appendectomy has not been established. We evaluated whether implementation of a telephone-based follow-up pathway was noninferior to an in-person follow-up model for 30-day emergency department (ED) visits. METHODS: We conducted a single-center retrospective cohort study of patients <18 years undergoing appendectomy for uncomplicated acute appendicitis between 2020 and 2025 using a Pediatric Health Information System query with manual chart review. On November 1, 2022, a telephone-based follow-up pathway was implemented. Pre- vs. post-implementation cohorts were compared. The primary outcome was a related ED visit within 30 days. Noninferiority was prespecified at an absolute margin of 3 percentage points using a one-sided 97.5% confidence interval (CI). RESULTS: Among 1,570 patients (738 pre-, 832 post-implementation), receipt of telephone follow-up increased from 10.3% (n=76) to 65.7% (n=547) (p<0.001), and completion of any postoperative follow-up increased from 65.3% to 73.3% (p=0.002). Thirty-day related ED visits occurred in 32 (4.3%) patients pre-implementation and 28 (3.4%) post-implementation. The adjusted absolute risk difference was -1.03 percentage points (one-sided 97.5% CI, -∞ to +0.85), below the prespecified 3-percentage-point noninferiority margin. CONCLUSIONS: Implementation of a telephone-based follow-up pathway after uncomplicated pediatric appendectomy was noninferior for 30-day related ED visits, while improving overall follow-up completion and reducing the need for burdensome in-person visits.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.