Standardization and improvement of care for pediatric patients with perforated appendicitis

Slusher, Joyce; Bates, Christina; Johnson, Catherine; Williams, Christina; Dasgupta, Roshni; Allmen, Daniel von

doi:10.1016/j.jpedsurg.2014.01.045

Cited by 45 publications

(39 citation statements)

References 7 publications

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“…Though perforation in this study was based on clinical impression of individual surgeon and not on strict objective criteria, they had similar rate of identification of postoperative abscess after discharge. In addition, readmission for treatment of postoperative abscess was 7% for patients within 30 days of original discharge [14]. In our study, identification of postoperative abscess after discharge was similar in both groups.…”

Section: Discussionsupporting

confidence: 62%

Safety of a new protocol decreasing antibiotic utilization after laparoscopic appendectomy for perforated appendicitis in children: A prospective observational study

Desai,

Alemayehu,

Holcomb

et al. 2015

Journal of Pediatric Surgery

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Section: Discussionsupporting

confidence: 62%

Safety of a new protocol decreasing antibiotic utilization after laparoscopic appendectomy for perforated appendicitis in children: A prospective observational study

Desai,

Alemayehu,

Holcomb

et al. 2015

Journal of Pediatric Surgery

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“…Time without fever was one of the most common discharge criteria. 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 .…”

Section: Resultsmentioning

confidence: 99%

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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“…1 Local guidelines have successfully standardized appendicitis care, suggesting that antimicrobial stewardship programs could support selecting narrowerspectrum antibiotics for children with appendicitis (and particularly uncomplicated appendicitis) whenever appropriate. 19,20 Strengths of the present study include the cohort size, exclusion of patients whose exposure or complication status was difficult to classify, and multiple subgroup analyses to explore the consistency of observed associations. This study also has limitations.…”

Section: Discussionmentioning

confidence: 99%

Extended- Versus Narrower-Spectrum Antibiotics for Appendicitis

Kronman

Oron²,

Ross

et al. 2016

Pediatrics

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Standardization and improvement of care for pediatric patients with perforated appendicitis

Cited by 45 publications

References 7 publications

Safety of a new protocol decreasing antibiotic utilization after laparoscopic appendectomy for perforated appendicitis in children: A prospective observational study

Safety of a new protocol decreasing antibiotic utilization after laparoscopic appendectomy for perforated appendicitis in children: A prospective observational study

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

Extended- Versus Narrower-Spectrum Antibiotics for Appendicitis

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