Postoperative Activity Restrictions in Children

Study Overview
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Brief Summary
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This study will investigate the need for and length of postoperative activity restrictions in children following a laparoscopic appendectomy or inguinal hernia repair. Currently, no consensus exists and restrictions are based on doctors' experience and preference. Children and their parents/guardians will decide if they wish to participate in this study. Those who wish to participate and who are eligible to participate will decide which postoperative activity restrictions they would like the child to follow. The child will follow either 1) doctor-directed restrictions or 2) self-directed restrictions.A parent or guardian will complete a survey 1-3 months after the procedure, to assess patient and family satisfaction and patient outcome.

Detailed Description
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Postoperative activity restrictions minimize the risk of surgical complications and prevent stress on the operative site. In the pediatric population, surgeons may restrict school attendance, participation in playground or gym, and participation in contact sports or heavy lifting. Currently, surgeons give pediatric patients postoperative restrictions following routine pediatric procedures (laparoscopic appendectomy and inguinal hernia repair) without evidence-based clinical practice guidelines. However, there is considerable variability amongst surgeons. It is common practice to provide some level of postoperative restrictions, which are primarily based on the surgeon's experience.While many surgeons prescribe specific postoperative instructions, some recommend self-directed restrictions. Self-directed restrictions instruct that the child return to school and normal physical activity when they and parents feel they are able to do so. There is no evidence that this practice is associated with any adverse outcomes. This study will utilize a convenience sample of pediatric patients treated at Beaumont Royal Oak and Troy for routine inguinal hernia repair and laparoscopic appendectomy. There will be two populations: patients undergoing the procedures (Patient population) and their parents/guardians (Parent population) who will be completing the postoperative survey. The Principal Investigator will review the operating room schedule and identify patients who are scheduled for either of the two procedures.Parents and patients who are eligible to participate in the study will be approached, the study explained and voluntary consent obtained. The participants will be provided an information sheet detailing the study, the risks, and the benefits. The researchers will describe the two groups the participant can enroll in. If the parents decide to enroll their child in the study they will then choose to be in either the control group (physician-directed) or the variable group (self-directed). The control group will be those individuals who choose physician-directed instructions which detail that they can resume all normal activity 2 weeks after their procedure. The experimental group will be those individuals who choose self-directed instructions which specify that they may return to full activity when their pain is improving and the parent feels comfortable with them doing so. For each group, the family will be provided with discharge instructions, a copy of these discharge instructions are provided in the study documents. A parent or guardian will complete a postoperative survey 1-3 months post procedure. The survey will assess: time of pain medication, time to return to school, time to resume full activity, wound healing, postoperative complications, changes in pain, compliance with instructions, patient satisfaction, time parent took off from work, if additional childcare was needed following the procedure, and parental satisfaction with the procedure and postoperative instructions.

Official Title
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Postoperative Activity Restrictions in Children

Conditions
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Pediatric Post-operative Time to Return to Full Activity

Intervention / Treatment
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* Other: Postoperative activity restrictions


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for Patients: Patient being treated at Royal Oak or Troy Beaumont for a routine inguinal hernia repair or appendectomy For inguinal hernia repair: 2-13 years of age For appendectomy: less than 18 years Exclusion Criteria for Patients: Older than 18 years of age upon admission Patients with perforated or complicated appendicitis For laparoscopic appendectomy: patient required a conversion to open appendectomy Patient experienced a complicated procedure or concomitant operation Inclusion Criteria for Parent/Guardians: 18 years or older Their child meets the inclusion criteria for participation in this study Exclusion Criteria for Parent/Guardians: Less than 18 years of age Their child does not meet the inclusion criteria for participation in this study

Ages Eligible for Study
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Minimum Age: 0 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Prospective, nonrandomized, parallel
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Physician-directed Postoperative Activity Restriction<br>Postoperative activity restrictions prescribed by physician. | Other: Postoperative activity restrictions<br>* Recommendations for return to full activity including return to school, sports, exercise, etc.<br>|
| Other: Self-directed Postoperative Activity Restriction<br>Postoperative activity restrictions self-determined (parent/guardian and/or patient). | Other: Postoperative activity restrictions<br>* Recommendations for return to full activity including return to school, sports, exercise, etc.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post operative Outcomes - Clinical Complications | Number of participants who developed post op complications | six weeks post op | 
| Post operative Outcomes - Patient Satisfaction (combination of child, parent and satisfaction with discharge guidelines) | Number of participants scoring a cumulative 12 or greater using a satisfaction scale ranging from Very Satisfied = 5 to Very Dissatisfied = 1 for each of the three satisfaction factors (child, parent, and satisfaction with discharge guidelines). | six weeks post op | 
| Post operative Outcomes - Length of time to return to full activity | Mean/SD number of days to return to full activity | six weeks post op | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of families choosing self-directed post operative instructions | Number of families who chose self-directed post operative instructions | six weeks post op | 
| Number of families choosing physician-directed post operative instructions | Number of families who chose physician-directed post operative instructions | six weeks post op | 
| Number of parental days off work taken in the self-directed post operative course group versus physician-directed course group | Mean/SD number of days parents took off work during the post operative period | six weeks post op | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Post-operative activity restriction, Pediatric inguinal hernia repair, Pediatric laparoscopic appendectomy