MANAGEMENT OF COMPLICATED APPENDICITIS - A RATIONAL APPROACH BASED ONCLINICAL COURSE

Objective: To better define the appropriate management of children wit h complicated appendicitis, using an outcome approach based on clinica l parameters. Design: Retrospective study. Setting: A 500-bed tertiary care university-based hospital. Patients: Fifty-six consecutively adm itted children (age <19 years) with a diagnosis of complicated appendi citis (gangrenous or perforated) confirmed at laparotomy. Intervention : All children were managed postoperatively using an institutionally e stablished protocol requiring hospitalization and broad-spectrum intra venous antibiotics until three criteria were met permitting discharge: (1) resolution of fever for 24 hours; (2) normalization of white bloo d cell count; and (3) normal results of clinical examination. Main Out come Measures: Length of stay, costs, and infectious complications. Re sults: 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. Conclus ions: Postoperative management of complicated appendicitis can be safe ly based on a defined clinical algorithm that should replace empirical therapy as the ''gold standard.''