Postoperative Activity Restrictions in Children
Postoperative Activity Restrictions in Children
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.
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.
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