Decreased resource utilization since initiation of institutional clinical pathway for care of children with perforated appendicitis

PurposeWe instituted a clinical pathway for the care of patients with perforated appendicitis based on outcomes from several clinical trials. The objective of this study was to review effects on resource utilization with this protocol.MethodsA retrospective review was conducted to compare all patients undergoing appendectomy during initial admission for perforated appendicitis prior to the pathway (July 2001 to December 2003) to after (December 2008 to March 2011). Demographics and management strategies were evaluated.ResultsCharts of 151 patients prior to and 259 after the start of the pathway were reviewed. The percentage of patients leaving the operating room with a nasogastric tube (NGT) was significantly lower in the after-group, while similar numbers of patients during each period had a NGT placed on the floor. The proportion of patients receiving peripherally inserted central catheters and total parenteral nutrition, and the number of intravenous antibiotics per day and lab draws were significantly reduced with the protocol. Patients were started on a regular diet significantly earlier, and length of stay was shortened by more than one day.ConclusionThe evidence-based clinical pathway developed from prospective trials has drastically reduced resource utilization for children with perforated appendicitis.