Outcomes and Resource Utilization Associated with Use of Routine Pre-Discharge White Blood Cell Count for Clinical...

Area of Science:

• Pediatric Surgery
• Healthcare Outcomes Research
• Clinical Pathology

Background:

• Complicated appendicitis in children necessitates careful management to optimize outcomes.
• Routine pre-discharge white blood cell (WBC) utilization is a practice in some pediatric centers.
• The relationship between this practice and patient outcomes requires investigation.

Purpose of the Study:

• To examine the hospital-level association between routine pre-discharge WBC utilization (RPD-WBC) and patient outcomes in pediatric complicated appendicitis.
• To determine if increased RPD-WBC use correlates with better or worse resource utilization and clinical outcomes.

Main Methods:

• A multicenter analysis of NSQIP-Pediatric data from 14 hospitals was performed.
• RPD-WBC data was augmented, defining routine use as WBCs obtained within one day of discharge without fever or organ space infection (OSI).
• Hospital-level observed-to-expected (O/E) ratios for 30-day outcomes were calculated and correlated with RPD-WBC utilization.

Main Results:

• Significant hospital-level variation existed in RPD-WBC use (0.7-100%) and all measured outcomes (antibiotic days, imaging, healthcare days, OSI).
• No statistically significant correlation was found between hospital-level RPD-WBC utilization and O/E ratios for antibiotic days (r=+0.14), imaging (r=-0.07), healthcare days (r=+0.35), or OSI (r=-0.13).

Conclusions:

• Increased routine pre-discharge WBC utilization in pediatric complicated appendicitis is not associated with improved patient outcomes.
• The study suggests that hospital-level RPD-WBC use does not correlate with better resource management or reduced complications.