Fast‐track surgery for uncomplicated appendicitis in children: a matched case–control study

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Excerpt

Variation in health care is abundant. Even among high‐volume surgical pathologies such as appendicitis in children, remarkable differences in care occur on local, regional, national and international scales.1 These differences are driven by numerous factors that include clinician preferences, resource availabilities, financial constraints, expectations of patient populations, and evidence‐base insufficiencies.2 Integrated pathways that standardize care are effective in reducing variation and enhancing efficiency.2 Importantly, they also offer opportunities for improvements from a patient perspective.2 Patients may benefit from these initiatives by reductions in unnecessary delays, higher consistency and transparency in care pathways, and allocation of resources that more closely match their specific needs.4
The Health Roundtable is a not‐for‐profit organization in Australasia that conducts large‐scale auditing to benchmark outcome data among participating hospitals within our region. Appendicitis was recently selected as an index paediatric pathology for auditing. Findings of this audit confirmed wide variability in outcomes that prompted us to design and implement a standardized protocol for uncomplicated appendicitis in children. Our concept for protocol‐based care was further motivated by the emergence of increasingly rationalized pathways for both uncomplicated and complicated appendicitis in children, published by North American and United Kingdom groups.7
The goal of our multidisciplinary criteria‐led discharge (CLD) protocol was to facilitate safe, consistent and expeditious post‐operative care. The objective of this study is to investigate its comparative effect on length of hospital stay, complications, antibiotic usage, opioid analgesia usage, anti‐emetic requirement and cost.
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