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

Archives of Surgery
M S KellerD W Vane

Abstract

To better define the appropriate management of children with complicated appendicitis, using an outcome approach based on clinical parameters. Retrospective study. A 500-bed tertiary care university-based hospital. Fifty-six consecutively admitted children (age <19 years) with a diagnosis of complicated appendicitis (gangrenous or perforated) confirmed at laparotomy. 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. Length of stay, costs, and infectious complications. 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. Postoperative management of complicated appendicitis can be safely based on a d...Continue Reading

Citations

Dec 10, 2014·Journal of Pediatric Surgery·David E SkardaEric Scaife
Dec 16, 2003·American Journal of Surgery·Thomas R WeberKim Vierling
Dec 22, 2005·World Journal of Surgery·Dennis W Vane, Nathanial Fernandez
Mar 28, 2008·Surgical Infections·Evan P NadlerUNKNOWN Therapeutic Agents Committee of the Surgical Infection Society
Jul 27, 2005·Pediatric Surgery International·Marion C W Henry, R Lawrence Moss
Nov 26, 1999·The Pediatric Infectious Disease Journal·D J HoelzerJ T Zern
Feb 15, 2001·The Pediatric Infectious Disease Journal·J S BradleyE R Wald

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