It is not what you do, it is the way that you do it: impact of a care pathway for appendicitis.
OBJECTIVE
Appendicitis is the most common surgical emergency in children. However, management varies widely. The aim of this study was to assess the impact of introducing a care pathway on the management of childhood appendicitis.


METHODS
Data were collected prospectively for 3 successive cohorts: All patients operated for suspected appendicitis were included. The pathway was modified after interim analysis of group B data. P < .05 was significant.


RESULTS
Six hundred patients were included. When compared with group A, group C patients were more likely to receive preoperative antibiotics (P < .0001), undergo formal pain assessment (P < .0001), and be operated before midnight (P = .025). There was a significant decrease in readmission rates from 10.0% to 4.2% (P = .023) despite an increase in cases of gangrenous and perforated appendicitis (P = .010).


CONCLUSIONS
The introduction of a care pathway resulted in improved compliance with antibiotic regimens, more frequent pain assessment, and fewer post-midnight operations. Postappendicectomy readmission rates were reduced despite an increase in disease severity. This was achieved by critical reevaluation of outcomes and pathway redesign where appropriate.
Almond
Sarah L
SL
Department of Paediatric Surgery, Royal Liverpool Children's NHS Trust, L12 2AP Liverpool, UK. salmond@liv.ac.uk
Roberts
Megan
M
Joesbury
Victoria
V
Mon
Sue
S
Smith
Jeff
J
Ledwidge
Nevila
N
Pisipati
Sailaja
S
Khan
Amir
A
Khalil
Basem A
BA
White
Elvina
E
Baillie
Colin T
CT
Kenny
Simon E
SE
D000293:Adolescent; D000704:Analysis of Variance; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019091:Critical Pathways; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome