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March 1996

Management of Complicated AppendicitisA Rational Approach Based on Clinical Course

Author Affiliations

From the Department of Pediatric Surgery, University of Vermont College of Medicine, Burlington.

Arch Surg. 1996;131(3):261-264. doi:10.1001/archsurg.1996.01430150039006

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)