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 study was to determine the impact of an evidence-based clinical pathway for acute appendicitis on patient care as well as hospital and home care costs at the auth...

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Bibliographic Details
Published in:Journal of pediatric surgery 1998-09, Vol.33 (9), p.1371-1375
Main Authors: Warner, Brad W., Kulick, Roy M., Stoops, Marilyn M., Mehta, Sanjeev, Stephan, Maria, Kotagal, Uma R.
Format: Article
Language:English
Subjects:
Acute Disease
Adolescent
Appendectomy - economics
Appendicitis - surgery
Biological and medical sciences
Chi-Square Distribution
Child
Child, Preschool
Critical Pathways
Emergencies
Evaluation Studies as Topic
Evidence-Based Medicine
Female
Hospital Costs - statistics & numerical data
Humans
Infant, Newborn
Intestinal Perforation - surgery
Length of Stay - economics
Length of Stay - statistics & numerical data
Male
Medical sciences
Prospective Studies
Rupture, Spontaneous
Statistics, Nonparametric
Stomach, duodenum, intestine, rectum, anus
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
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Summary:Background/Purpose: In the pediatric population, appendicitis remains the most common surgical emergency encountered. The purpose of this study was to determine the impact of an evidence-based clinical pathway for acute appendicitis on patient care as well as hospital and home care costs at the authors' pediatric institution. Methods: A prospective evaluation was conducted of an appendicitis clinical pathway (June 1996 through November 1996) compared with historical control patients (June 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% for P) were similar. Pathway patients with nonperforated appendicitis were more often discharged from 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 shorter 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 $7,823 ± $2,366 for P; P = .0001). Conclusion: An evidence-based appendicitis pathway decreased duration of hospitalization and cost without adversely affecting diagnosis or therapy. Clinical pathways for surgical diagnoses may prove useful as a means to minimize costs without compromising patients care.
ISSN:0022-3468
1531-5037
DOI:10.1016/S0022-3468(98)90010-0