Effectiveness of a clinical pathway for pediatric complex appendicitis based on antibiotic stewardship principles
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In brief
In brief
This study evaluated a clinical pathway for pediatric complex appendicitis that limits postoperative antibiotics based on clinical criteria rather than routine lab monitoring or discharge oral antibiotics. Analysis of 510 patients showed no increase in complications or readmissions, demonstrating safe antibiotic reduction.
Written by the GCMD Library team from the article.
Purpose
Outcomes and resource utilization were evaluated after implementing a novel complex appendicitis (CA) pathway limiting postoperative antibiotics based on clinical parameters.
Methods
Children with intraoperative CA (gangrenous, perforated, or abscess) were treated with intravenous antibiotics postoperatively until clinical criteria were met, without utilizing CBC or oral antibiotics at discharge. An interrupted time series (pre-intervention, transition, post-intervention) was used to assess outcomes. Hospital length of stay (LOS) was analyzed using segmented regression. Intra-abdominal abscess and readmission rates were analyzed using non-inferiority and multivariate logistic regression.
Results
Five hundred ten children were included with a median age of 10 [IQR7–12] years. There were no differences in postoperative LOS (slope − 0.008; p = 0.855), intra-abdominal abscess rate (5% vs. 8%; p = 0.135), or readmission rate (12% vs. 8%; p = 0.113) across time periods which remained true when adjusting for age, gender, and intraabdominal disease severity. Post-intervention outcomes were not inferior to pre-intervention, abscess rate (p = 0.002), or readmission rate (p