Related Experiment Video

Updated: Mar 16, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation
11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

18.8K

Measuring the Value of a Clinical Practice Guideline for Children With Perforated Appendicitis

Jamie R Robinson1, Elenir B C Avritscher, James C Gay

  • 1*Department of Pediatric Surgery, Vanderbilt Children's Medical Center, Nashville, TN †Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN ‡Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX §Department of Pediatrics, Vanderbilt Children's Medical Center, Nashville, TN ¶Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX ||Department of Finance, Vanderbilt University Medical Center, Nashville, TN.

Annals of Surgery
|August 9, 2016
PubMed

Insights

Implementing a clinical practice guideline (CPG) for perforated appendicitis in children significantly reduced adverse events and hospital costs. This evidence-based approach improved surgical care value, demonstrating cost-effectiveness.

Area of Science:

  • Pediatric Surgery
  • Health Economics
  • Clinical Practice Guidelines

Background:

  • Value-based surgical care emphasizes measuring outcomes relative to costs.
  • Measuring both outcomes and costs together is crucial but rarely performed.

Purpose of the Study:

  • To determine the cost-effectiveness of a clinical practice guideline (CPG) versus usual care for pediatric perforated appendicitis.
  • To compare cost analysis using hospital accounting data versus the Pediatric Health Information System (PHIS).

Main Methods:

  • A cohort of 122 children with perforated appendicitis were treated with an evidence-based CPG.
  • Clinical outcomes and costs were compared to a pre-CPG cohort (n=191).
  • Cost data were analyzed from hospital accounting systems and the PHIS database.

Main Results:

  • CPG implementation decreased the intra-abdominal abscess rate from 0.24 to 0.10.
  • Mean total hospital costs per patient decreased by $5,938 (from $16,466 to $10,528).
  • Bayesian cost-effectiveness analysis showed a 91% likelihood that the CPG was the dominant strategy.

Conclusions:

  • An evidence-based CPG improved surgical care value for pediatric perforated appendicitis by enhancing outcomes and reducing costs.
  • Both hospital accounting data and PHIS database provided comparable cost reduction results.
Abstract

More Related Videos

Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults04:14

Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults

Published on: February 28, 2025

988

Related Concept Videos

Appendicitis-II: Diagnostic Studies and Management01:29

Appendicitis-II: Diagnostic Studies and Management

Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
714
Appendicitis-I: Introduction01:22

Appendicitis-I: Introduction

The appendix, a small, narrow, blind tube extending from the inferior part of the cecum, is widely regarded as a vestigial organ, having lost much of its original function through evolution. Despite its diminished role, the appendix can become inflamed, a condition known as appendicitis.
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
3.2K
Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
896
Inflammatory Bowel Disease V: Surgical Management01:21

Inflammatory Bowel Disease V: Surgical Management

Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
Here are some common surgical interventions for IBD:
811
Esophageal Perforation-I: Introduction01:22

Esophageal Perforation-I: Introduction

Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
719
Endoscopic Procedures V: ERCP01:26

Endoscopic Procedures V: ERCP

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
5.1K