Haifaa M Malaekah
Princess Nourah Bint Abdulrahman University, Saudi Arabia
Title: Acute Appendicitis Pathway: A Systematic Review
Biography
Biography: Haifaa M Malaekah
Abstract
Background & Aim: Despite the effectiveness of Clinical Pathways (CP) in reducing healthcare cost and minimizing variability in the management of particular diseases, there are no standardized pathways for common conditions such as appendicitis. This study aimed to determine whether implementation of a pathway for appendicitis leads to improved patient care.
Methods: A systematic review was performed of PUBMED, MEDLINE and Cochrane Library from 1974 to December 2015. The inclusion criteria were human, appendicitis, CP, original article and English language. 37 of the identified studies comprised of 16,006 participants met selection criteria.
Results: There was a clear definition of the appendicitis pathway within 30 articles. Appendicitis was diagnosed on the basis of clinical and laboratory findings. 43% of the studies added radiological investigations. There was a clear definition for discharge criteria in 16/37 studies. 10 studies reported time of follow-up for their patients (5-28 days). Operative time was the most commonly used outcome measure 25/37 (67.5 %). Nine articles reported the Length of Stay (LOS) for non-complicated appendicitis, mean=1.3 days and 8 articles for complicated appendicitis, mean=6.26 days. The majority of studies investigated the accuracy of the pathway in the diagnosis of appendicitis by looking at the incidence of a normal appendix, mean=9.15%. Four articles documented the mean cost of patient care, mean=$4,874.14.
Conclusion: There is not a standardized definition of appendicitis pathway components within the medical literature. These studies suggested that an appendicitis pathway decreases the duration of hospitalization and prove useful as a means to minimize costs.