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

Background/Purpose

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.

Methods

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.

Results

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.

Conclusion

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

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