Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals.

BACKGROUND/PURPOSE To improve clinical results and resource utilization in the care of appendicitis in children, the authors examined the current practice and outcomes of 30 pediatric hospitals. METHODS The Pediatric Health Information System (PHIS) database consists of comparative data from 30 free-standing Children's hospitals. The study population of 3,393 children was derived from the database by selecting the "Diagnosis Related Group Code" for appendicitis (APRDRGv12 164), ages 0 to 17 years, using discharges between October 1, 1999 and September 30, 2000. Data are expressed as the range and median for individual hospital outcomes. RESULTS The nonpositive appendectomy rate ranged from 0 to 17% at the 30 hospitals (median, 2.6%). Ruptured appendicitis varied from 20% to 76% (median, 36.5%). The median length of stay (LOS) for nonruptured appendicitis was 2 days (range, 1.4 to 3.1 days), ruptured appendicitis varied from 4.4 to 11 days (median, 6 days). The median readmission rate within 14 days was 4.3% (0 to 10%). Laparoscopic appendectomy varied from 0 to 95% in the 30 hospitals (mean, 31%) The LOS did not vary significantly in laparoscopic versus open for nonruptured (2.3 v 2.0 days) or ruptured appendicitis (5.5 v 6.2 days). Days on antibiotics for ruptured appendicitis ranged from 4.6 to 7.9 days (median, 5.9 days) Children receiving any study varied from 18% to 89% (median, 69%). Ultrasound scan and computed tomography (CT) were comparable in both nonruptured (13% ultrasound scan v 14%) and ruptured appendicitis (14% ultrasound scan v 21% CT). CONCLUSIONS Significant variability in practice patterns and resource utilization exists in the management of acute appendicitis in pediatric hospitals. Clinical outcomes could be improved by collaborative initiatives to adopt evidence-based best practices.

[1]  M. Silen,et al.  A state-wide evaluation of appendectomy in children. , 1999, American journal of surgery.

[2]  S. Stylianos.  Outcome studies and practice guidelines in trauma. , 2002, Seminars in pediatric surgery.

[3]  D. Flum,et al.  Has misdiagnosis of appendicitis decreased over time? A population-based analysis. , 2001, JAMA.

[4]  D. Zabel,et al.  Determining duration of antibiotic use in children with complicated appendicitis. , 1999, The Pediatric infectious disease journal.

[5]  B. Warner,et al.  The sustained impact of an evidenced-based clinical pathway for acute appendicitis. , 2002, Seminars in pediatric surgery.

[6]  Success factors and hurdles in quality improvement in a children's hospital. , 2002, Seminars in pediatric surgery.

[7]  K. Chavanu,et al.  Guiding practice improvements in pediatric surgery using multidisciplinary clinical pathways. , 2002, Seminars in pediatric surgery.

[8]  L. Strausbaugh.  Infection control in long-term care: news from the front. , 1999, American journal of infection control.

[9]  K. Newman,et al.  Using a pediatric database to drive quality improvement. , 2002, Seminars in pediatric surgery.

[10]  P. Clifford,et al.  Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. , 1982, The New England journal of medicine.

[11]  R. Tauxe,et al.  The epidemiology of appendicitis and appendectomy in the United States. , 1990, American journal of epidemiology.

[12]  M. Secic,et al.  Specialty versus generalist care of children with appendicitis: an outcome comparison. , 2001, Journal of pediatric surgery.

[13]  W. Hardin,et al.  Evidence-based practice in pediatric surgery. , 1999, Journal of pediatric surgery.

[14]  K. Heiss.  Victim or player: pediatric surgeons deal with quality improvement and the information age. , 2002, Seminars in pediatric surgery.

[15]  B. Littenberg,et al.  Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. , 1999, Surgical laparoscopy & endoscopy.