Acute Appendicitis Pathway: A Systematic Review | 102305
Journal of Gastrointestinal & Digestive System
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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
Haifaa M Malaekah is a General surgery and Colorectal Consultant and Member of Saudi Society for Colon and Rectal Surgery and Manager of Postgraduate Professional Development Program at simulation center. He is a certified healthcare simulation educator. Currently, he is working at King Abdullah bin Abdulaziz University Hospital at surgical Department. In addition, he has obtained a Master’s degree in Epidemiology and Medical Statistics. He has accomplished 2 years of Fellowship in Colorectal Surgery at 2015, University de Montreal and 1 year Fellowship in Surgical Simulation, McGill University, Canada. He continued working in McGill University as Postdoctoral Fellow for 6 months. He has an interest in medical education, simulation and researches.