The research, led by Murdoch Children’s Research Institute (MCRI) and published in the Journal of Pediatric Surgery, found more than 40 per cent who received care in the home following a complex appendectomy recovered faster and had fewer complications.

More than 300 patients present with appendicitis to The Royal Children’s Hospital (RCH) every year, with about one in three experiencing a burst appendix or severe infection.

The study involved 83 children, aged five to 18 years, admitted to the RCH for a complicated appendicectomy, with 35 suitable for the Hospital in the Home (HITH) program. All patients needed at least five days of intravenous antibiotics (IV) post-surgery. Under the program, a nurse visited the child’s home daily to administer the antibiotics and record clinical observations.

MCRI Associate Professor Penelope Bryant said under this model, patients at home recovered more quickly and didn’t require readmission to hospital.

“Acute post-operative care at home is rare, but we found it’s possible for children to spend 35 per cent less time in hospital after complicated surgery,” she said. This could be done safely and without prolonging IV courses or broadening antibiotic use.

“These findings will help clinicians to identify which children are suitable for HITH care following surgery for complicated appendicitis.”

MCRI Associate Professor Warwick Teague said the HITH program, used heavily during the COVID-19 pandemic, had the added benefits of reduced hospital and family costs, improved quality of life, less time taken from work and prevention of hospital-acquired infections.

“The pandemic presented us with the need and opportunity to deliver care to children in their home,” he said. This study showed even children who had severe appendicitis can be well cared for at home after surgery, freeing up hospital beds for other sick children and those needing surgery.

“Traditionally after surgery for severe appendicitis, surgeons have insisted on daily reviews in hospital by the surgical team. However, in this study we learnt that optimal postoperative care be delivered at home, by well-trained non-surgical clinicians working as a team with surgeons.”

“For complicated appendicitis, the HITH program also saved over $1,400 per day for the hospital and $300 daily for families, reducing cost-of-living pressures with longer-term benefits for healthcare sustainability.”

Researchers from The Royal Children’s Hospital and University of Melbourne contributed to the study.

Joint senior author Associate Professor Nic Rawlence, Director of the Otago Palaeogenetics Laboratory, says while elephant seals now only inhabit the subantarctic islands and South America, Aotearoa beaches used to be “heaving” with the colossal animals.

“At the time of human arrival in New Zealand, you would be hard pressed to find room on the beaches, with fur seals on the rocky headlands, prehistoric sealions and elephant seals on the sand, and lots of penguins,” he says.

“It’s a picture that is very hard to imagine today, especially as most New Zealanders wouldn’t think that these majestic giants were once part of our biological heritage.”

The study was undertaken by a group of international researchers, led by postgraduate students Andrew Berg, of the University of Sydney, and Otago’s Megan Askew, and recently published in the leading journal Global Change Biology.

They used palaeogenetic techniques on specimens dating back thousands of years from New Zealand, Tasmania and Antarctica to show that southern elephant seals used to be spread across the entire Southern Ocean.

Joint senior author Dr Mark de Bruyn, of Griffith University, says their whereabouts was heavily impacted by climate change and humans over a short evolutionary period.

“The Ice Ages would have rapidly increased the amount of sea ice surrounding Antarctica, forcing elephant seals to retreat to multiple refugia in South Africa, Australia, New Zealand and South America, before they expanded back out as the climate warmed, including temporarily to the Antarctic mainland,” Dr de Bruyn says.

“However, indigenous subsistence hunting and European industrial sealing once again resulted in the contraction of their range, this time to the deep Southern Ocean with their extirpation from Australia and New Zealand.”

Associate Professor Rawlence says knowing how elephant seals responded to these changes will provide insights into how they — and the Southern Ocean ecosystem, which New Zealand and Australia are part of — may be impacted in the future.

“Their dynamic evolutionary history, plus climate change and human impact, strongly suggests that unless measures are taken to mitigate the effects of human-driven climate change and marine ecosystem deterioration, elephant seals and the Southern Ocean ecosystem are in for a rough ride into the future,” he says.