Haifaa Malaekah, MBBS, MSCE, Fahad Makhdom, MBBS, FRCSC, Aggarwal Rajesh, MBBS, MA, PHD, FRCS, FRCSC, FACS. Mcgill University
Introduction: Despite the effectiveness of clinical pathways in reducing healthcare cost and minimizing variability in management of particular disease; there is no standardized pathways for common conditions such as appendicitis. This systematic review aimed to determine whether implementation of a pathway for acute appendicitis in surgical practice leads to improve patient care.
Methods: A systemic review was performed of PUBMED, MEDLINE and Cochrane Library from 1974 to December 2015.The inclusion criteria were human, appendicitis, clinical pathway, original article and English language. Abstracts of retrieved studies were reviewed and those meeting inclusion criteria were selected for full review. Thirty-seven of the identified studies comprised of 16,006 participants met the selection criteria.
Results: There was a clear definition of the appendicitis pathway within 30 articles. However, only 7 articles studied the effect of three components of pathways in their patients. The diagnosis of appendicitis was mainly based on clinical presentation and laboratory findings. 43% of the studies used US and/or CT scan for diagnosis of appendicitis. There was a clear definition for discharge criteria in 16/37 studies. Ten studies reported time of follow up for their patients, which ranged from 5 to 28 days. Operative time was the most commonly used outcome measure 25/37 (67.5%). Nine articles reported length of stay for non-complicated appendicitis, mean=1.3 days; and eight articles for complicated appendicitis, mean= 6.26 days. Majority of studies investigated the accuracy of pathway in diagnosis of appendicitis by looking at incidence of normal appendix, mean=9.15%. 4/37 articles documented the mean cost of patient’s care, mean=4,874.14 $.
Conclusions: There is a lack of standardized definition of appendicitis pathway components within the medical literature. In addition, few studies identify standards setting for discharge criteria for their patients. Nevertheless, these studies suggested that appendicitis pathway decreases duration of hospitalization and may prove useful as a means to minimize costs. Implementation of an evidence based appendicitis pathway is needed to standardized patients’ care and improve outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79080
Program Number: P329
Presentation Session: Poster (Non CME)
Presentation Type: Poster