Adoption and Implementation of Evidence-based Practices Into Pediatric Appendectomy Care

PURPOSE: Many children's hospitals have implemented elements of evidence-based practice (EBP) for the diagnosis and management of uncomplicated and complicated pediatric appendicitis. As successful implementation of evidence into practice can take years, this study evaluated the adoption and implementation of EBPs for pediatric appendicitis over the past eight years.

METHODS: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (2015-2022) was queried for patients undergoing appendectomy for acute appendicitis. Practices evaluated included the use of any imaging at any institution, parenteral and oral antibiotics use at discharge, peripherally inserted central catheter (PICC) line use, postoperative percutaneous drain use, and same day discharge.

RESULTS: A total of 135,412 children underwent appendectomy for acute appendicitis (72.2 % simple; 27.8% complicated). From 2015 to 2022, for children with uncomplicated appendicitis, the use of oral antibiotics at discharge decreased from 10.0 to 5.8% (p< 0.001), while same day discharges increased from 69.4 to 82.6% (p< 0.001). Among children with complicated appendicitis, there were decreases in postoperative practices of percutaneous drain placement (12.5 to 8.5%, p< 0.001), PICC use (10.0 to 5.1%, p< 0.001) and parenteral antibiotics at discharge (3.0 to 0.9%, p< 0.001), while the use of oral antibiotics at discharge increased from 50.9 to 69.3% (p< 0.001). The use of postoperative computed tomography in complicated appendicitis remained unchanged, but the use of magnetic resonance imaging increased from 0.8% to 1.1% and ultrasound increased from 9.1 to 12.5% (p< 0.001).

CONCLUSION: EBPs are being increasingly utilized in pediatric appendicitis care for both uncomplicated and complicated appendicitis.