Texas Children's Hospital, Division of Pediatric Surgery, 6701 Fannin Street, Houston, TX 77030.
Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
J Pediatr Surg. 2020 Jun;55(6):1026-1031. doi: 10.1016/j.jpedsurg.2020.02.045. Epub 2020 Mar 3.
Outcomes and resource utilization were evaluated after implementing a novel complex appendicitis (CA) pathway limiting postoperative antibiotics based on clinical parameters.
Children with intraoperative CA (gangrenous, perforated, or abscess) were treated with intravenous antibiotics postoperatively until clinical criteria were met, without utilizing CBC or oral antibiotics at discharge. An interrupted time series (pre-intervention, transition, post-intervention) was used to assess outcomes. Hospital length of stay (LOS) was analyzed using segmented regression. Intra-abdominal abscess and readmission rates were analyzed using non-inferiority and multivariate logistic regression.
Five hundred ten children were included with a median age of 10 [IQR7-12] years. There were no differences in postoperative LOS (slope - 0.008; p = 0.855), intra-abdominal abscess rate (5% vs. 8%; p = 0.135), or readmission rate (12% vs. 8%; p = 0.113) across time periods which remained true when adjusting for age, gender, and intraabdominal disease severity. Post-intervention outcomes were not inferior to pre-intervention, abscess rate (p = 0.002), or readmission rate (p < 0.001). Intraoperative findings of perforation (OR9.0; 95% CI1-71; p = 0.044) and perforation with abscess (OR18.2; 95% CI2-36; p = 0.005) were associated with a greater likelihood of postoperative abscess compared to gangrenous appendicitis.
A CA protocol based on clinical parameters is safe and effective, resulting in similar intra-abdominal abscess and readmission rates compared to more resource-intense regimens.
III TYPE OF RESEARCH: Interrupted Time Series.
评估实施一种新的复杂阑尾炎（CA）路径后基于临床参数限制术后抗生素使用的结果和资源利用情况。
术中 CA（坏疽性、穿孔性或脓肿性）患儿术后给予静脉抗生素治疗，直到符合临床标准，出院时不使用 CBC 或口服抗生素。采用中断时间序列（干预前、过渡期、干预后）评估结果。采用分段回归分析住院时间（LOS）。采用非劣效性和多因素逻辑回归分析腹腔脓肿和再入院率。
共纳入 510 例患儿，中位年龄为 10 [IQR7-12] 岁。在术后 LOS 方面（斜率为-0.008；p=0.855）、腹腔脓肿发生率（5%比 8%；p=0.135）或再入院率（12%比 8%；p=0.113）方面，各时间段之间无差异，当调整年龄、性别和腹腔疾病严重程度后，结果仍如此。干预后结局不劣于干预前，脓肿发生率（p=0.002）或再入院率（p<0.001）。穿孔（OR9.0；95%CI1-71；p=0.044）和穿孔伴脓肿（OR18.2；95%CI2-36；p=0.005）的术中表现与术后脓肿发生的可能性较坏疽性阑尾炎更大相关。
基于临床参数的 CA 方案是安全有效的，与资源密集型方案相比，术后腹腔脓肿和再入院率相似。
III 级 研究类型：中断时间序列。
