Tips

From Other Journals

Care Protocols Reduce Appendectomy Complications



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2002 Nov 1;66(9):1773-1776.

Appendectomy is the fourth most common abdominal surgery performed in the United States. Up to 18 percent of patients have postoperative infectious complications ranging in significance from wound infection to intra-abdominal abscess. The rate of infections depends on the degree of contamination during surgery and reaches nearly one third of cases when the appendix is perforated or gangrenous. Helmer and colleagues studied the effect of an evidence-based clinical practice guideline in reducing infectious complications of appendectomy.

Appendicitis Protocol

FIGURE.

Standardized protocol for management of appendicitis. (CT = computed tomographic scan; IV = intravenous; WBC = white blood cell)

Adapted with permission from Helmer KS, Robinson EK, Lally KP, Vasquez JC, Kwong KL, Liu TH, et al. Standardized patient care guidelines reduce infectious morbidity in appendectomy patients. Am J Surg 2002;183:609.

View Large

Appendicitis Protocol


FIGURE.

Standardized protocol for management of appendicitis. (CT = computed tomographic scan; IV = intravenous; WBC = white blood cell)

Adapted with permission from Helmer KS, Robinson EK, Lally KP, Vasquez JC, Kwong KL, Liu TH, et al. Standardized patient care guidelines reduce infectious morbidity in appendectomy patients. Am J Surg 2002;183:609.

Appendicitis Protocol


FIGURE.

Standardized protocol for management of appendicitis. (CT = computed tomographic scan; IV = intravenous; WBC = white blood cell)

Adapted with permission from Helmer KS, Robinson EK, Lally KP, Vasquez JC, Kwong KL, Liu TH, et al. Standardized patient care guidelines reduce infectious morbidity in appendectomy patients. Am J Surg 2002;183:609.

The clinical practice protocol that was developed from a critical review of the literature (see accompanying figure) was applied to 206 patients with a presumptive diagnosis of appendicitis who presented to a Texas county hospital during 1999. Outcomes in this cohort of patients were compared with those in 232 patients treated for the same condition at the hospital during the previous year. No patients were excluded from the study. Data were gathered on demographic and surgical features, comorbidities, use of antibiotics, evidence of infection, and other complications during the hospital stay.

Eight patients (4 percent) who were treated according to the protocol had postoperative surgical infections, compared with 20 patients (9 percent) in the comparison group. The number of patients with intra-abdominal abscesses dropped from 12 to five after introduction of the protocol, and the number of wound infections dropped from 14 to four. The improvement was particularly significant in patients presenting with a perforated or gangrenous appendix. In these patients, the total number of infections dropped from 16 (33 percent) to five (13 percent).

The authors conclude that use of an evidence-based clinical practice guideline can significantly reduce surgically related infections following appendectomy and is particularly effective in patients with perforation or gangrene of the appendix.

Helmer KS, et al. Standardized patient care guidelines reduce infectious morbidity in appendectomy patients. Am J Surg. June 2002;183:608–13.

editor's note: It is good to see the application of evidence-based practice result in positive outcomes for a common condition. This study should be directly applicable to practice in many locations, although the antibiotics selected for this study (gentamicin, levofloxacin, metronidazole, cefotetan, and imipenem) probably are not those of first choice in most institutions. The authors do not tell us how they persuaded all surgeons to adhere to the protocol (if they did). Getting consensus to consistently implement a clinical guideline is the most difficult part of the entire process. One wishes that they had measured additional outcomes, such as length of stay or reduction in other infections, especially of the respiratory and urinary tracts. Those of us who might be tempted to introduce the protocol into our own hospitals need all the available information to persuade our colleagues to abdicate personal practice preferences in favor of evidence-based protocols.—a.d.w.

 

Copyright © 2002 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

Navigate this Article