Measuring the Value of a Clinical Practice Guideline for Children With Perforated Appendicitis

Abstract

An evidence-based CPG increased the value of surgical care for children with perforated appendicitis by improving outcomes and lowering costs. Hospital cost accounting data and pre-existing cost data within the PHIS database provided similar results.

Perforation risk in pediatric appendicitis: assessment and management

“… 59 Current standard of care and practice guidelines advocate for the early initiation of antibiotics in treatment algorithms. 32 , 62 – 65 After initiation of antibiotics, treatment options diverge into operative management or non-operative management with or without interval appendectomy. Although there continues to be extensive debate regarding the merits of each treatment option, this review will highlight the indications for each option and propose an algorithm to assist with treatment decisions.…”

“…Although the diagnosis and management of perforated appendicitis remains complex and controversial, guidelines exist and have been demonstrated to both improve patient outcomes and decrease resource utilization. 31 , 32 , 62 – 64 Although clinician experience is the best tool in making an accurate diagnosis, 5 , 21 , 36 laboratory studies and selective imaging should be utilized to assist in diagnosis. After a diagnosis of perforated appendicitis is made, all patients should be placed nil per os and started on appropriate broad-spectrum IV antibiotics.…”

Improving the value of care for appendectomy through an individual surgeon-specific approach

“…Acquisition of patient-level cost data by surgeons is difficult in most healthcare systems as costs are either not available or aggregated over time or departmentally, rather than provided at the patient-level. [1, 8, 13, 14] We have previously shown that institution of a clinical practice guideline (CPG) for perforated appendicitis resulted in a decrease in variability of care, improvement in clinical outcomes, and decrease in overall cost of care. [14, 15] This CPG did not incorporate any intraoperative changes, such as standardization of OR equipment or incentives for OR cost reduction.…”

European Paediatric Surgeons' Association Survey on the Management of Pediatric Appendicitis

“…To minimize practice variation, optimize healthcare resources, and avoid unnecessary treatments, evidence-based clinical practice guidelines for children with appendicitis have been developed. [2][3][4][5][6][7][8][9] However, despite the advantages of improving outcomes and lowering costs, the guidelines produced by various associations and institutions have not unanimously been accepted. For instance, in 2010, the Dutch Society of Surgeons introduced guidelines that recommended the routine use of ultrasound and/or computed tomography (CT) for the diagnosis of acute appendicitis.…”