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Improving Pediatric Surgery Quality by Widely Adopting an Evidence-based Protocol: An Effort of the Pediatric Surgery

Jeannette M Joly1,2,3, Monica E Lopez3,4, Erich J Grethel3,5

  • 1Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston and Children's Memorial Hermann Hospital, Houston, TX.

Annals of Surgery
|June 25, 2025
PubMed

Insights

This study shows that adopting a short-course antibiotic protocol for pediatric complicated appendicitis significantly reduced antibiotic days without increasing surgical site infections. This quality improvement initiative standardized care across multiple institutions.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Quality Improvement

Background:

  • Short-course antibiotics are evidence-based for intra-abdominal infections but underutilized in pediatric care.
  • The Pediatric Surgery Quality Collaborative (PSQC) proposed a standardized short-course antibiotic protocol for complicated appendicitis postappendectomy.

Purpose of the Study:

  • To assess the widespread adoption of an evidence-based, short-course antibiotic protocol in pediatric complicated appendicitis.
  • To evaluate the impact of this protocol across multiple institutions.

Main Methods:

  • An observational quality improvement study involving 36 PSQC hospitals.
  • Patients were analyzed based on protocol adoption (4+/-1 antibiotic days) versus usual care.
  • Statistical analysis included multivariable regressions with propensity scoring and inverse probability of treatment weighting.

Main Results:

  • The protocol was adopted by 21 hospitals; 15 continued usual care, with 1934 patients analyzed.
  • Protocol adoption was associated with a significant reduction in total antibiotic days (mean 5.8 vs. 8.4 days).
  • No significant difference in 30-day surgical site infection (SSI) rates was observed between the protocol and usual care groups (12.7% vs. 13.6%).

Conclusions:

  • Multicenter adoption of the short-course antibiotic protocol led to care standardization and quality improvement in pediatric surgery.
  • The protocol effectively reduced antibiotic exposure without compromising patient safety regarding SSI rates.
Abstract

Keywords:
antimicrobial stewardshipappendicitisclinical protocolmulticenter studypediatricsquality improvement

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