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 $224 000 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."
(Arch Surg. 1996;131:261-264)
