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Related Experiment Videos

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
PubMed
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.

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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:

Related Experiment Videos

  • 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.