Decreased resource utilization since initiation of institutional clinical pathway for care of children with perforated appendicitis

Knott, E. Marty; Gasior, Alessandra C.; Ostlie, Daniel J.; Holcomb, George; Peter, Shawn D. St.

doi:10.1016/j.jpedsurg.2013.03.044

Cited by 31 publications

(23 citation statements)

References 16 publications

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“…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%

“…The trend towards monotherapy in more recent studies is supported by favourable results for this strategy, although an intravenous broad‐spectrum cephalosporin (e.g. ceftriaxone) accompanied by metronidazole is also reported as safe and effective . Transition to oral antibiotics on completion of an IV regimen is common practice.…”

Section: Resultsmentioning

confidence: 99%

“…Standardization of blood test and imaging acquisition was implemented in numerous protocols . Five studies restricted ordering of computed tomography scans to only after the seventh post‐operative day if the child was not meeting discharge criteria, or there was clinical suspicion of an intra‐abdominal abscess .…”

Section: Resultsmentioning

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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“…Most notably, in lower gastrointestinal surgery, the development and use of ERAS guidelines has shown reduced LOS by 2.55 days ( P < 0.001) and complication rates reduced 53% ( P < 0.001) in patients after major open colorectal surgery . Other examples where clinical pathways have improved nutritional care include use of enteral feeding protocols, early nutrition initiation in intensive care units and prevention of unnecessary parenteral nutrition use after surgery . One limitation to this study was the difficulty of measuring via a telephone survey a direct link between actual patient outcomes and presence of a clinical pathway.…”

Section: Discussionmentioning

confidence: 99%

Nutritional management of gastrointestinal surgical patients in Victoria's public hospitals

Barker

Crowe

2014

Nutrition & Dietetics

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Aim:Poor nutritional status has negative effects on post-operative outcomes, further compounded by surgical stress and fasting, places gastrointestinal surgery patients at high risk of malnutrition. Recent published research has challenged historic surgical nutrition practices; however, changes to practice in Australia have been slow. The aim of this study was to investigate current nutritional management of gastrointestinal surgery patients and compare this with the best practice guidelines, while exploring enablers to implementation of best practice. Methods: A 30-question telephone survey was developed to explore demographics and nutritional management of gastrointestinal surgical patients during pre-admission, inpatient stay and post-operative care. Forty-one gastrointestinal surgery dietitians were identified and contacted from 31 public hospitals in Victoria, Australia, and invited to participate. Results: Twenty-five dietitians participated in the survey (response rate 61%). Very few dietitians (12%) were funded for pre-admission clinics or outpatient clinics, and, overwhelmingly, dietitians reported not being involved in nutritional decision-making, and reported feeling unsatisfied with current nutritional management of patients. Despite half the hospitals reporting following best practice guidelines, only 22% implemented guidelines completely. There was no correlation observed between dietitian experience, department size or full-time equivalents allocated to surgery and nutritional intervention; however, the presence of a care pathway made a significant difference to the dietitian's overall satisfaction with dietetic care (P = 0.002). Conclusions: Current nutritional management of gastrointestinal surgery patients in Victorian hospitals is far from best practice. The implementation of a care pathway is the most effective way of ensuring best practice nutritional management of gastrointestinal surgical patients.

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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%

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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Decreased resource utilization since initiation of institutional clinical pathway for care of children with perforated appendicitis

Cited by 31 publications

References 16 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

Nutritional management of gastrointestinal surgical patients in Victoria's public hospitals

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

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