What are the true advantages of a pediatric appendicitis clinical pathway?
Multiple protocols have been described for pediatric appendicitis, but few have been compared with off-protocol treatment. We performed such a comparison. Children treated for appendicitis by three pediatric surgeons over a 28-month period were studied. A protocol of primary wound closure without drains, standardized use of antibiotics, and patient discharge according to pre-determined clinical criteria was compared with individualized drain use, antibiotic selection, and discharge timing. Three hundred ninety-seven children were treated, 43 per cent on pathway (Group I) and 57 per cent off pathway (Group II). The two groups showed similar incidence of acute (45% vs 46%), complicated (50% vs 49%), and normal (5%) appendix. Among patients with simple appendicitis, Group I had less postoperative antibiotic use (16% vs 80% P < 0.001), shorter hospital stays (1.44 vs 1.89 days, P = 0.001), and decreased hospital charges (dollars 9,289 vs dollars 10,751, P = 0.001). Among patients with complicated appendicitis, Group I had less drain placement (4% vs 27%, P < 0.001), less use of discharge antibiotics (13% vs 39%, P < 0.001), and no readmission (0% vs 5%, P = 0.05). Infectious complications were similar between the two groups. A clinical pathway decreases the use of unnecessary antibiotics, hospital stay, and charges for simple appendicitis. It decreases the use of unnecessary drains, and eliminates readmissions after complicated appendicitis.
Emil
Sherif
S
Division of Pediatric Surgery, Department of Surgery, University of California, Irvine Children's Hospital, Orange 92868, USA.
Taylor
Michael
M
Ndiforchu
Fombe
F
Nguyen
Nam
N
D018784:Abdominal Abscess / Q000209:etiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001064:Appendicitis / Q000601:surgery*; D001065:Appendix / Q000033:anatomy & histology; D002648:Child; D019091:Critical Pathways; D004322:Drainage / Q000295:instrumentation; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents