Benefits of standardization in the management of acute appendicitis.

I Planas Díaz, L Díaz Menéndez, R Cabello Laureano, M Molina
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Abstract

Objective: Acute appendicitis (AA) is the most frequent urgent surgical pathology in the pediatric population, but postoperative management is variable, with protocols minimizing variability. We present our results following the optimization of the management protocol in our institution in order to establish its efficacy in terms of number of infectious complications and optimization of resources in our environment.

Materials and methods: An observational, retrospective study of patients undergoing AA surgery from January 2018 to August 2022 was carried out. Two cohorts were compared, both before (1) and after (2) the implementation of the new protocol. They were divided according to severity in order to conduct a subgroup-based analysis -phlegmonous (PH), gangrenous (G), and perforated (P) appendicitis.

Results: 771 patients (1: 390; 2: 381) were included, with a homogeneous distribution and a median age of 9.3 ± 2.8 years. Blood tests requested prior to discharge experienced a significant reduction (PH: 3.9% vs. 0.5%; p= 0.026; G: 97.6% vs. 13.4%, p< 0.001). Days of hospital stay decreased in the PH (1.2 IQR: 0.7 vs. 1 IQR: 0.36; p< 0.001) and G (4 IQR: 1 vs. 3 IQR: 1 days; p< 0.001) subgroups. No differences in the number of abscesses were found between groups (41 vs. 43; p= 0.73), but they were noted within subgroup G (9 vs. 2; p= 0.029). A reduction in resource expenses was detected in PH and G appendicitis.

Conclusions: In our study, the most widely benefited subgroup following protocol optimization was the gangrenous appendicitis subgroup, with a significant reduction in the number of complications and the use of hospital resources.

急性阑尾炎标准化管理的益处。
目的:急性阑尾炎(AA)是儿科最常见的急诊手术病理,但术后管理却不尽相同,如何最大限度地减少方案的可变性?我们将介绍本院优化管理方案后的结果,以确定其在感染性并发症数量和优化环境资源方面的有效性:对2018年1月至2022年8月接受AA手术的患者进行了一项观察性、回顾性研究。对新方案实施前(1)和实施后(2)的两组患者进行了比较。根据严重程度进行分组分析--痰性(PH)、坏疽性(G)和穿孔性(P)阑尾炎:共纳入 771 名患者(1:390;2:381),分布均匀,中位年龄为 9.3 ± 2.8 岁。出院前要求进行的血液检查显著减少(PH:3.9% 对 0.5%;P= 0.026;G:97.6% 对 13.4%,P= 0.026):在我们的研究中,方案优化后受益最大的亚组是坏疽性阑尾炎亚组,并发症数量和医院资源使用量显著减少。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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