AN EVIDENCED-BASED CLINICAL PATHWAY FOR ACUTE APPENDICITIS DECREASES HOSPITAL DURATION AND COST

Background/Purpose: In the pediatric population, appendicitis remains the most common surgical emergency encountered. The purpose of this st udy was to determine the impact of an evidence-based clinical pathway for acute appendicitis on patient care as well as hospital and home ca re costs at the authors' pediatric institution. Methods: A prospective evaluation was conducted of an appendicitis clinical pathway (June 19 96 through November 1996) compared with historical control patients (J une 1994 through November 1994) not cared for by the pathway. Results: Data (average +/- SD) for 120 pathway (P) patients were compared with 122 control (C) patients. Age (11.5 +/- 3.6 years for C v 11.2 +/- 3. 9 years for P), rates of negative appendectomy (12.3% for C v 9.2% for P) and perforation (26.2% for C v 18.3% far P) were similar. Pathway patients with nonperforated appendicitis were more often discharged fr om the hospital within 24 hours (48% for C v 67% for P; P = .014) with lower hospital costs ($4,095 +/- $1,280 for C v $3,638 +/- $1,633 for P; P = .001). Pathway patients with perforated appendicitis had short er hospitalization (185.2 +/- 59 hours for C v 113 +/- 44 hours for P; P = .0001) and lower hospital costs ($11,175 +/- $3,893 for C v $7,82 3 +/- $2,366 for P; P = .0001). Conclusion: An evidence-based appendic itis pathway decreased duration of hospitalization and cost without ad versely affecting diagnosis or therapy. Clinical pathways for surgical diagnoses may prove useful as a means to minimize costs without compr omising patient care. Copyright (C) 1998 by W.B. Saunders Company.