From the Division of Pediatric Surgery, University of Calgary, Alberta Children's Hospital, Calgary, Alta. (Lam, Beaudry, Brindle); and Clinical Analytics, Alberta Health Services, Alberta Children's Hospital, Calgary, Alta. (Simms).
Can J Surg. 2021 Jul 5;64(4):E364-E370. doi: 10.1503/cjs.005420.
In 2017, a provincial guideline was created to fast track and standardize care for pediatric appendicitis in Alberta. We conducted a study to determine the impact of implementation of the guideline at our institution on length of stay (LOS), antibiotic stewardship efforts and costs.
We performed a retrospective review of the charts of all patients younger than 18 years of age who underwent appendectomy at our institution in 2 periods: before guideline implementation (Dec. 1, 2016, to May 31, 2017) and after implementation (Dec. 1, 2017, to May 31, 2018). We compared LOS, duration of antibiotic therapy, 30-day postdischarge complication rates and variable cost between the 2 cohorts.
Of the 276 total appendectomy procedures performed, 185 were for simple appendicitis (81 before guideline implementation and 104 after implementation), and 91 were for complicated appendicitis (44 and 47, respectively). The median LOS was shorter in the postimplementation cohort for both simple and complicated appendicitis (15.5 h [interquartile range (IQR) 12-19 h] v. 17.0 h [IQR 13-22 h], p = 0.03; and 3.0 d [IQR 2-4 d] v. 3.0 d [IQR 3-5 d], p = 0.05, respectively). Patients with complicated appendicitis had fewer antibiotic days after guideline implementation; the difference was statistically significant for patients without diffuse peritoneal contamination or abscess formation (p = 0.02). There were no differences between the cohorts with respect to 30-day rates of complications, including emergency department visits, readmission and surgical site infections. After guideline implementation, the average variable cost per patient was reduced by $230, equating to a total average annual cost savings of $75 842 for our institution.
The implementation of a provincial guideline aimed at standardizing care in pediatric appendicitis at our institution was associated with shortened LOS, improved antibiotic stewardship efforts and reduced cost of care. Other institutions may replicate our model of a standardized pathway in the management of pediatric appendicitis in an effort to improve the quality of patient care and reduce health care costs.
2017 年，艾伯塔省制定了一项省级指南，旨在加快并规范小儿阑尾炎的治疗。我们进行了一项研究，以确定该指南在我院实施后对住院时间（LOS）、抗生素管理工作和成本的影响。
我们对在我院接受阑尾切除术的所有 18 岁以下患者的病历进行了回顾性分析，研究分为两个阶段：指南实施前（2016 年 12 月 1 日至 2017 年 5 月 31 日）和实施后（2017 年 12 月 1 日至 2018 年 5 月 31 日）。我们比较了两组之间的 LOS、抗生素治疗持续时间、30 天出院后并发症发生率和可变成本。
在总共 276 例阑尾切除术手术中，185 例为单纯性阑尾炎（指南实施前 81 例，实施后 104 例），91 例为复杂性阑尾炎（分别为 44 例和 47 例）。在简单和复杂阑尾炎的术后队列中， LOS 中位数均较短（15.5 小时[四分位距（IQR）12-19 小时]比 17.0 小时[IQR 13-22 小时]，p = 0.03；3.0 天[IQR 2-4 天]比 3.0 天[IQR 3-5 天]，p = 0.05）。复杂性阑尾炎患者在指南实施后抗生素使用天数减少；对于无弥漫性腹膜污染或脓肿形成的患者，差异具有统计学意义（p = 0.02）。在 30 天内的并发症发生率方面，两组之间没有差异，包括急诊科就诊、再入院和手术部位感染。在指南实施后，每位患者的平均可变成本降低了 230 美元，相当于我院每年可节省 75842 美元的平均总成本。
在我院实施旨在规范小儿阑尾炎治疗的省级指南与 LOS 缩短、抗生素管理工作改善和医疗成本降低有关。其他机构可以复制我们的小儿阑尾炎管理标准化途径模式，以提高患者护理质量并降低医疗保健成本。
