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Article
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
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 $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)

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