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Perforated appendicitis: prospective outcome analysis for 150 children.
S J Fishman1, L Pelosi, S L Klavon
1Department of Surgery, Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Journal of Pediatric Surgery
|June 29, 2000
Summary
This study shows that a new protocol for perforated appendicitis using a single antibiotic, piperacillin-tazobactam, and allowing outpatient treatment maintains low complication rates. This approach effectively manages appendicitis while reducing costs and length of hospital stay.
Area of Science:
- Surgical outcomes research
- Infectious disease management
- Healthcare economics
Background:
- Management of perforated appendicitis involves ongoing debate regarding antibiotic selection, duration, operative timing, drain use, and wound closure.
- Previous protocols at the institution utilized a multi-drug regimen for 10 inpatient days with drains, achieving low complication rates.
- Current healthcare pressures emphasize reduced length of stay and cost, potentially compromising clinical outcomes.
Purpose of the Study:
- To evaluate if modified management protocols for perforated appendicitis could maintain excellent clinical outcomes while decreasing costs and length of stay.
- To assess the efficacy and safety of a new protocol involving a single broad-spectrum antibiotic and early outpatient transition.
Main Methods:
- Prospective monitoring of clinical outcomes in 150 patients with perforated appendicitis over 43 months.
- Treatment involved intravenous piperacillin-tazobactam for 10 days, with potential for the final 5 days of therapy to be administered via a percutaneous intravenous catheter at home.
- Key elements of the prior protocol, including immediate surgery, Penrose drains, and primary wound closure, were maintained.
Main Results:
- Major complications were low: intra-abdominal abscess (3.3%), cecal fistula (1.3%), phlegmon (2.0%), and wound infection (2.7%).
- No small bowel obstructions requiring surgery occurred.
- The complication rates were not significantly different from a historical cohort of 373 patients treated under the previous, more intensive protocol.
Conclusions:
- A modified protocol using a single broad-spectrum antibiotic, piperacillin-tazobactam, can effectively treat perforated appendicitis with minimal infectious complications.
- This approach allows for cost savings through outpatient administration of the final antibiotic course without compromising quality of care.
- The study provides essential outcome data for comparison with future treatment modifications aimed at reducing healthcare costs.