Andrew B Nordin1, Karen Diefenbach2, Stephen P Sales3, Jeff Christensen4, Gail E Besner5, Brian D Kenney6. 1. Nationwide Children's Hospital, Department of Pediatric Surgery, 700 Children's Drive, Columbus, OH, 43205; State University of New York University at Buffalo, Department of General Surgery, 100 High St, Buffalo, NY 14203. Electronic address: abnordin@buffalo.edu. 2. Nationwide Children's Hospital, Department of Pediatric Surgery, 700 Children's Drive, Columbus, OH, 43205; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210. Electronic address: Karen.Diefenbach@nationwidechildrens.org. 3. Nationwide Children's Hospital, Department of Pediatric Surgery, 700 Children's Drive, Columbus, OH, 43205. Electronic address: Stephen.Sales@nationwidechildrens.org. 4. Nationwide Children's Hospital, Department of Pediatric Surgery, 700 Children's Drive, Columbus, OH, 43205. Electronic address: Jeff.Christensen@nationwidechildrens.org. 5. Nationwide Children's Hospital, Department of Pediatric Surgery, 700 Children's Drive, Columbus, OH, 43205; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210. Electronic address: Gail.Besner@nationwidechildrens.org. 6. Nationwide Children's Hospital, Department of Pediatric Surgery, 700 Children's Drive, Columbus, OH, 43205; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210. Electronic address: Brian.Kenney@nationwidechildrens.org.
Abstract
BACKGROUND: Appendicitis presents on a spectrum ranging from inflammation to gangrene to perforation. Studies suggest that gangrenous appendicitis has lower postoperative infection rates relative to perforated cases. We hypothesized that gangrenous appendicitis could be successfully treated as simple appendicitis, reducing length of stay (LOS) and antibiotic usage without increasing postoperative infections. METHODS: In February 2016, we strictly defined complex appendicitis as a hole in the appendix, extraluminal fecalith, diffuse pus or a well-formed abscess. We switched gangrenous appendicitis to a simple pathway and reviewed all patients undergoing laparoscopic appendectomy for 12 months before (Group 1) and 12 months after (Group 2) the protocol change. Data collected included demographics, appendicitis classification, LOS, presence of a postoperative infection, and 30-day readmissions. RESULTS: Patients in Group 1 and Group 2 were similar, but more cases of simple appendicitis occurred in Group 2. Average LOS for gangrenous appendicitis patients decreased from 2.5 to 1.4 days (p < 0.001) and antibiotic doses decreased from 5.2 to 1.3 (p < 0.001). Only one gangrenous appendicitis patient required readmission, and one patient in each group developed a superficial infection; there were no postoperative abscesses. CONCLUSIONS: Gangrenous appendicitis can be safely treated as simple appendicitis without increasing postoperative infections or readmissions. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level II.
BACKGROUND:Appendicitis presents on a spectrum ranging from inflammation to gangrene to perforation. Studies suggest that gangrenous appendicitis has lower postoperative infection rates relative to perforated cases. We hypothesized that gangrenous appendicitis could be successfully treated as simple appendicitis, reducing length of stay (LOS) and antibiotic usage without increasing postoperative infections. METHODS: In February 2016, we strictly defined complex appendicitis as a hole in the appendix, extraluminal fecalith, diffuse pus or a well-formed abscess. We switched gangrenous appendicitis to a simple pathway and reviewed all patients undergoing laparoscopic appendectomy for 12 months before (Group 1) and 12 months after (Group 2) the protocol change. Data collected included demographics, appendicitis classification, LOS, presence of a postoperative infection, and 30-day readmissions. RESULTS:Patients in Group 1 and Group 2 were similar, but more cases of simple appendicitis occurred in Group 2. Average LOS for gangrenous appendicitispatients decreased from 2.5 to 1.4 days (p < 0.001) and antibiotic doses decreased from 5.2 to 1.3 (p < 0.001). Only one gangrenous appendicitispatient required readmission, and one patient in each group developed a superficial infection; there were no postoperative abscesses. CONCLUSIONS:Gangrenous appendicitis can be safely treated as simple appendicitis without increasing postoperative infections or readmissions. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level II.
Authors: N Ensor; K R Qin; M Sivasubramaniam; B Roddis; K Mayakaduwage; M Pacilli; R M Nataraja Journal: World J Surg Date: 2021-09-23 Impact factor: 3.352
Authors: Christopher Pennell; Teerin Meckmongkol; L Grier Arthur; Sean Ciullo; Rajeev Prasad; Erika Lindholm; Harsh Grewal Journal: Pediatr Qual Saf Date: 2020-10-26