Yousef Yasmine, Youssef Fouad, Homsy Michael, Dinh Trish, Pandya Kartikey, Stagg Hayden, Baird Robert, Laberge Jean-Martin, Poenaru Dan, Puligandla Pramod, Shaw Kenneth, Emil Sherif
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
J Pediatr Surg. 2017 Dec;52(12):1916-1920. doi: 10.1016/j.jpedsurg.2017.08.054. Epub 2017 Sep 5.
The treatment of perforated appendicitis in children is characterized by significant variability in care, morbidity, resource utilization, and outcomes. We prospectively studied how minimization of care variability affects outcomes.
A clinical pathway for perforated appendicitis, in use for three decades, was further standardized in May 2015 by initiation of a disease severity classification, refinement of discharge criteria, standardization of the operation, and establishment of criteria for use of postoperative total parenteral nutrition, imaging, and invasive procedures. Prospective evaluation of all children treated for 20months on the new fully standardized protocol was conducted and compared to a retrospective cohort treated over 58months prior to standardization. Differences between outcomes before and after standardization were analyzed using regression analysis techniques to adjust for disease severity.
Median follow-up time post discharge was 25 and 14days in the post- and prestandardization groups, respectively. Standardization significantly reduced postoperative abscess (9.8% vs. 17.4%, p=0.001) and hospital stay (p=0.002). Standardization reduced the odds of developing a postoperative abscess by four fold.
Minimizing variability of care at all points in the treatment of perforated appendicitis significantly improves outcomes.
Prospective Cohort Study.
Level II.
儿童穿孔性阑尾炎的治疗在护理、发病率、资源利用和治疗结果方面存在显著差异。我们前瞻性地研究了护理差异最小化如何影响治疗结果。
一条使用了三十年的穿孔性阑尾炎临床路径于2015年5月通过启动疾病严重程度分类、完善出院标准、规范手术操作以及制定术后全肠外营养、影像学检查和侵入性操作的使用标准得到进一步标准化。对按照新的完全标准化方案治疗20个月的所有儿童进行前瞻性评估，并与标准化之前58个月内治疗的回顾性队列进行比较。使用回归分析技术分析标准化前后治疗结果的差异，以调整疾病严重程度。
标准化后和标准化前组出院后的中位随访时间分别为25天和14天。标准化显著降低了术后脓肿发生率（9.8%对17.4%，p=0.001）和住院时间（p=0.002）。标准化使发生术后脓肿的几率降低了四倍。
在穿孔性阑尾炎治疗的各个环节将护理差异最小化可显著改善治疗结果。
前瞻性队列研究 。
二级 。
