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, 131 (3), 261-4

Management of Complicated Appendicitis. A Rational Approach Based on Clinical Course

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Management of Complicated Appendicitis. A Rational Approach Based on Clinical Course

M S Keller et al. Arch Surg.

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."

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