Management of complicated appendicitis. A rational approach based on clinical course.

Publication/Presentation Date

3-1-1996

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."

Volume

131

Issue

3

First Page

261

Last Page

264

ISSN

0004-0010

Disciplines

Medicine and Health Sciences | Pediatrics

PubMedID

8611090

Department(s)

Department of Pediatrics

Document Type

Article

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