Benefits of an abridged antibiotic protocol for treatment of gangrenous appendicitis

Shbat, Layla; Emil, Sherif; Elkady, Sherif; Baird, Robert; Laberge, Jean-Martin; Puligandla, Pramod S.; Shaw, Kenneth

doi:10.1016/j.jpedsurg.2014.09.039

Cited by 19 publications

(31 citation statements)

References 8 publications

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“…The required period without fever ranged between 12 and 72 hours . Only one small underpowered study explicitly excluded a body temperature value from their discharge criteria, with comparable complication rates and LOS reported . The importance of tolerating oral intake of fluid or solid diet, and adequate oral analgesia was heavily emphasized in many studies …”

Section: Resultsmentioning

confidence: 99%

“…A significant reduction in LOS was achieved in eight studies (Table S4). Importantly, in all but one study these outcomes occurred with either comparable or improved rates of complication or readmission . Yousef et al and Willis et al notably reported reductions in intra‐abdominal abscess rate by approximately half.…”

Section: Resultsmentioning

confidence: 99%

“…Compliance to the prescribed clinical pathway was varied between studies, with adherence to protocol elements ranging from 65% to 100% . Deviations from protocols typically resulted from failure of presentation to follow‐up clinic, failure to prescribe the standardized antibiotic course or provision of total parenteral nutrition .…”

Section: Discussionmentioning

confidence: 99%

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Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Do‐Wyeld

Rogerson

Court‐Kowalski

et al. 2019

ANZ Journal of Surgery

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Background ‘Fast‐track’ surgery protocols aim to standardize and rationalize post‐operative care, with evidence of safety and efficacy in both uncomplicated and complicated childhood appendicitis. Generalization for broader adoption has been limited by variation in protocol design, including specific antibiotic choice, discharge criteria, post‐operative monitoring and patient selection. Methods A systematic review of the literature was performed to evaluate the current evidence underpinning fast‐track protocols for childhood appendicitis and identify areas of consensus and controversy. Results About 33 studies met the inclusion criteria, including four prospective observational studies, 20 case–control studies, seven cohort studies and two randomized controlled trials studying uncomplicated (n = 9), complicated (n = 18) and mixed cohorts (n = 6). Reduction in length of hospital stay was almost universally reported, with equivalent or improved complication rates. Key themes of protocols included antibiotic choice and duration, discharge criteria and post‐operative laboratory and radiographic testing. Rationalized analgesia is an underexplored aspect of protocol design, and a standardized definition of complicated appendicitis remains elusive. Conclusion Standardized care of childhood appendicitis has been shown to be safe and effective in several local and international centres. Next steps include investigation of a complicated appendicitis protocol that integrates rationalized analgesia in appendicectomy recovery, and development of a consistent classification scheme for complicated disease to aid in identification of amenable cohorts.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Do‐Wyeld

Rogerson

Court‐Kowalski

et al. 2019

ANZ Journal of Surgery

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“…For uncomplicated appendicitis, characteristics of high volume and fairly narrow spectrum of disease severity lend themselves well to simple standardized post‐operative care protocols. Complicated appendicitis has a less predictable post‐operative recovery but studies are emerging that describe success for protocols that account for this more heterogeneous pathology …”

Section: Discussionmentioning

confidence: 99%

“…Complicated appendicitis has a less predictable postoperative recovery but studies are emerging that describe success for protocols that account for this more heterogeneous pathology. 12,15,31,32 Conclusion Implementation of a CLD protocol at our hospital for uncomplicated appendicitis in children decreased length of stay, reduced variation in care, preserved existing low morbidity, incurred substantial cost savings, and safely rationalized opioid and antiemetic medication. Unlike various surgical technology items that promise to improve efficiency and patient outcomes at high financial cost, standardized care protocols are costless and offer tangible benefits that are accessible to all health care settings.…”

Section: Future Directionsmentioning

confidence: 95%

Fast‐track surgery for uncomplicated appendicitis in children: a matched case–control study

Cundy

Sierakowski

Manna

et al. 2016

ANZ Journal of Surgery

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Association of Gangrenous, Suppurative, and Exudative Findings With Outcomes and Resource Utilization in Children With Nonperforated Appendicitis

et al. 2022

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IMPORTANCEThe clinical significance of gangrenous, suppurative, or exudative (GSE) findings is poorly characterized in children with nonperforated appendicitis. OBJECTIVE To evaluate whether GSE findings in children with nonperforated appendicitis are associated with increased risk of surgical site infections and resource utilization. DESIGN, SETTING, AND PARTICIPANTSThis multicenter cohort study used data from the Appendectomy Targeted Database of the American College of Surgeons Pediatric National Surgical Quality Improvement Program, which were augmented with operative report data obtained by supplemental medical record review. Data were obtained from 15 hospitals participating in the Eastern Pediatric Surgery Network (EPSN) research consortium. The study cohort comprised children (aged Յ18 years) with nonperforated appendicitis who underwent appendectomy from July 1, 2015, to June 30, 2020.EXPOSURES The presence of GSE findings was established through standardized, keyword-based audits of operative reports by EPSN surgeons. Interrater agreement for the presence or absence of GSE findings was evaluated in a random sample of 900 operative reports. MAIN OUTCOMES AND MEASURESThe primary outcome was 30-day postoperative surgical site infections (incisional and organ space infections). Secondary outcomes included rates of hospital revisits, postoperative abdominal imaging, and postoperative length of stay. Multivariable mixed-effects regression was used to adjust measures of association for patient characteristics and clustering within hospitals. RESULTS Among 6133 children with nonperforated appendicitis, 867 (14.1%) had GSE findings identified from operative report review (hospital range, 4.2%-30.2%; P < .001). Reviewers agreed on presence or absence of GSE findings in 93.3% of cases (weighted κ, 0.89; 95% CI, 0.86-0.92). In multivariable analysis, GSE findings were associated with increased odds of any surgical site infection (4.3% vs 2.2%; odds ratio [OR], 1.91; 95% CI, 1.35-2.71; P < .001), organ space infection (2.8% vs 1.1%; OR, 2.18; 95% CI, 1.30-3.67; P = .003), postoperative imaging (5.8% vs 3.7%; OR, 1.70; 95% CI, 1.23-2.36; P = .002), and prolonged mean postoperative length of stay (1.6 vs 0.9 days; rate ratio, 1.43; 95% CI, 1.32-1.54; P < .001). CONCLUSIONS AND RELEVANCEIn children with nonperforated appendicitis, findings of gangrene, suppuration, or exudate are associated with increased surgical site infections and resource utilization. Further investigation is needed to establish the role and duration of postoperative antibiotics and inpatient management to optimize outcomes in this cohort of children.

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Benefits of an abridged antibiotic protocol for treatment of gangrenous appendicitis

Cited by 19 publications

References 8 publications

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Fast‐track surgery for acute appendicitis in children: a systematic review of protocol‐based care

Fast‐track surgery for uncomplicated appendicitis in children: a matched case–control study

Association of Gangrenous, Suppurative, and Exudative Findings With Outcomes and Resource Utilization in Children With Nonperforated Appendicitis

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