title: Management of complicated appendicitis. A rational approach based on clinical course.
abstract: OBJECTIVE
  To better define the appropriate management of children with complicated appendicitis, using an outcome approach based on clinical parameters.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  A 500-bed tertiary care university-based hospital.
  
  
  METHODS
  Fifty-six consecutively admitted children (age <19 years) with a diagnosis of complicated appendicitis (gangrenous or perforated) confirmed at laparotomy.
  
  
  METHODS
  All children were managed postoperatively using an institutionally established protocol requiring hospitalization and broad-spectrum intravenous antibiotics until three criteria were met permitting discharge: (1) resolution of fever for 24 hours; (2) normalization of white blood cell count; and (3) normal results of clinical examination.
  
  
  METHODS
  Length of stay, costs, and infectious complications.
  
  
  RESULTS
  Overall, infectious complications occurred in only two patients (3.5%). No complications occurred in any patient who met the criteria for discharge. The average length of stay for all patients was 5.1+/-3.0 days (range, 3 to 18 days). Using this approach instead of current standards reported in the literature resulted in an estimated savings of over $4000 per patient and $224000 for the entire cohort.
  
  
  CONCLUSIONS
  Postoperative management of complicated appendicitis can be safely based on a defined clinical algorithm that should replace empirical therapy as the "gold standard."
authors.affiliation: Department of Pediatric Surgery, University of Vermont College of Medicine, Burlington, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Keller
authors.forename: W J
authors.initials: WJ
authors.lastname: McBride
authors.forename: D W
authors.initials: DW
authors.lastname: Vane
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001064:Appendicitis / Q000150:complications* / Q000191:economics / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005734:Gangrene; D017721:Hospital Costs; D006801:Humans; D007416:Intestinal Perforation / Q000191:economics / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome