Standardization of Care for Pediatric Perforated Appendicitis

This is Todd Ponsky with the Journal of Pediatric Surgery, and here's your two-minute review. Today we're gonna look at an article that was just published in the December issue of the Journal of Pediatric Surgery called Standardization of Care for Pediatric Perforated Appendicitis Improves Outcomes. The first author was Doctor Yusuf and the senior author was Doctor Sharif Emil. So as we all know, the way that pediatric surgery is done is quite variable. We all practice differently, but especially appendicitis. It's just not standardized. So this paper set out to determine if the implementation of a standardized treatment protocol for perforated appendicitis would improve outcomes. So at this hospital, a clinical pathway had been in place for about 30 years, but in 2015, they implemented a new pathway that did a few things different. For example, the new pathway initiated a disease severity classification. It refined the discharge criteria. It standardized the operative technique, and it established criteria for the use of postoperative TPN, for the use of postoperative imaging, and for the use of postoperative invasive procedures such as draining an abscess. They then prospectively evaluated the outcomes of all the children treated on the new fully standardized protocol over a period of 20 months and then compared it to all the patients who had been treated prior to standardization. In the 58 months prior to the implementation of the new standardized protocol. Medium follow-up time post-discharge was 14 days in the pre-standardized group and 25 days in the post-standardized group. So, what did they find? Standardization significantly reduced postoperative abscess and hospital stay. In fact, standardization reduced the odds of developing a postoperative abscess by 4 times. So I thought this was a pretty impressive study. I love the design of comparing a prospective cohort to a retrospective historical control. The fact that the abscess rate went down 4 times, this cannot be a coincidence. I love the way they did the study. Congratulations to the authors. Please leave your comments and questions below. We'll see you next time. Thanks.