Gangrenous appendicitis: No longer complicated
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Read the article on jpedsurg.org ↗Article · Dec 2018 · 1 min read
In brief
In brief
Protocol change reclassified gangrenous appendicitis from complex to simple, reducing average length of stay from 2.5 to 1.4 days without increasing postoperative infection rates. Study demonstrates that gangrenous appendicitis can be safely managed with shorter hospitalization and reduced antibiotic exposure when perforation is absent.
Written by the GCMD Library team from the article.
Background
Appendicitis presents on a spectrum ranging from inflammation to gangrene to perforation. Studies suggest that gangrenous appendicitis has lower postoperative infection rates relative to perforated cases. We hypothesized that gangrenous appendicitis could be successfully treated as simple appendicitis, reducing length of stay (LOS) and antibiotic usage without increasing postoperative infections.
Methods
In February 2016, we strictly defined complex appendicitis as a hole in the appendix, extraluminal fecalith, diffuse pus or a well-formed abscess. We switched gangrenous appendicitis to a simple pathway and reviewed all patients undergoing laparoscopic appendectomy for 12 months before (Group 1) and 12 months after (Group 2) the protocol change. Data collected included demographics, appendicitis classification, LOS, presence of a postoperative infection, and 30-day readmissions.
Results
Patients in Group 1 and Group 2 were similar, but more cases of simple appendicitis occurred in Group 2. Average LOS for gangrenous appendicitis patients decreased from 2.5 to 1.4 days (p