Improving quality and efficiency of care for advanced appendicitis in children
| Autor: | Laura L. Burgoyne, Sanjeev Khurana, Montgommery Do-Wyeld, Stefan Court-Kowalski, Rebecca Cooksey, Celia Cooper, Lynda Dandie, Thomas P. Cundy |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Intravenous analgesia medicine.drug_class media_common.quotation_subject Perforation (oil well) Gangrene 03 medical and health sciences 0302 clinical medicine medicine Appendectomy Humans Antiemetic Quality (business) Child Retrospective Studies media_common business.industry Suppurative appendicitis General Medicine Perioperative Length of Stay Appendicitis medicine.disease Patient Discharge Anti-Bacterial Agents 030220 oncology & carcinogenesis Emergency medicine 030211 gastroenterology & hepatology Surgery business Complication |
| Zdroj: | ANZ Journal of Surgery. 91:1497-1503 |
| ISSN: | 1445-2197 1445-1433 |
| DOI: | 10.1111/ans.16929 |
| Popis: | Background Complicated appendicitis encompasses a spectrum of severity with heterogeneity in definition and substantial variation in care. Enhanced recovery after surgery or 'fast-track' protocols aim to reduce practice variation by standardizing care. These initiatives may improve quality and efficiency of care, preserve resources and expedite discharge. This study aims to evaluate the impact of a standardized Enhanced Recovery Pathway (ERP) on the post-operative recovery of children with a subset of complicated appendicitis termed 'advanced' appendicitis. Methods We defined advanced appendicitis as gangrenous or suppurative appendicitis without perforation, contained iatrogenic perforation, or localized purulent fluid. Children with operative findings reflecting these criteria were enrolled in the ERP protocol. Key protocol components include early upgrade of diet, avoidance of intravenous analgesia, abridged intravenous antibiotics, early ambulation and standardized discharge criteria. The study period was May 2018 to June 2019. A historical cohort was used as the comparator group. Results Outcomes for 44 children treated under the ERP were compared to 44 historical controls. There was a 20% reduction in median post-operative length of stay (1.80 vs. 2.24 days, p = 0.02). Intravenous analgesia was received by fewer patients (6.8% vs. 36.4%, p = 0.01) with significant reduction in antiemetic requirement (p = 0.03). No significant difference in 30-day complication rates was observed. Conclusion Reduced post-operative length of stay and reduction in practice variation were achieved after implementation of a 'fast-track' protocol for children with advanced appendicitis. Additional benefits of this protocol include reduced provision of intravenous morphine analgesia, decreased resource use and cost savings. |
| Databáze: | OpenAIRE |
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