M S Keller1, W J McBride, D W Vane. 1. Department of Pediatric Surgery, University of Vermont College of Medicine, Burlington, USA.
Abstract
OBJECTIVE: To better define the appropriate management of children with complicated appendicitis, using an outcome approach based on clinical parameters. DESIGN: Retrospective study. SETTING: A 500-bed tertiary care university-based hospital. PATIENTS: Fifty-six consecutively admitted children (age <19 years) with a diagnosis of complicated appendicitis (gangrenous or perforated) confirmed at laparotomy. INTERVENTION: 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. MAIN OUTCOME MEASURES: 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."
OBJECTIVE: To better define the appropriate management of children with complicated appendicitis, using an outcome approach based on clinical parameters. DESIGN: Retrospective study. SETTING: A 500-bed tertiary care university-based hospital. PATIENTS: Fifty-six consecutively admitted children (age <19 years) with a diagnosis of complicated appendicitis (gangrenous or perforated) confirmed at laparotomy. INTERVENTION: 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. MAIN OUTCOME MEASURES: 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."