One Year Later: Standardization of Postoperative Appendectomy Management in General Pediatric Surgery

From the 2022 HVPA National Conference

Veronica Natale (Graduate, Johns Hopkins Hospital), Laurie Smith RN, MSN, Daniel Rhee MD


Based on ACS-NSQIP data indicating our institution was an outlier for postoperative outcomes for appendectomy procedures, we implemented a standard appendectomy management pathway. We identified key areas of improvement as (1) standardized definitions for disease severity integrated within an appendectomy-specific operative note template, and (2) establishment of criteria for antibiotic management.


We retrospectively reviewed the records of children who underwent Laparoscopic appendectomy during FY2021 year-to-date (n= 80) at a tertiary children’s hospital and evaluated compliance to our standard pathway. We compared our outcomes by evaluating pathway compliance and non-compliance between both complicated and uncomplicated appendicitis groups. These rates were then compared to our baseline analysis from FY2020 to evaluate the level of improvement.


Quantitative: Of the 80 Appendectomy procedures performed, 29 (36%) were classified as complicated. Of 8 revisits to the Emergency Department, 3 (10%) were complicated. There was one readmission within 30 days, and two organ space infections. Both Organ Space Infections and readmissions were more prevalent in complicated cases 2 (7%) and 1 (3%) respectively. 22 (76%) of these procedures were found to be compliant with the standardized appendectomy operative note and 28 (97%) were compliant with the standard antibiotic management pathway. Compared to our FY20 baseline, we saw a 40% decrease in ED revisits, and a 70% decrease in readmissions and surgical site infections.


Establishing a standardized pathway for postoperative management of appendicitis has resulted in fewer postoperative complications for complicated appendectomies.

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