An evidenced-based clinical pathway for acute appendicitis decreases hospital duration and cost

Brad W. Warner, Roy M. Kulick, Marilyn M. Stoops, Sanjeev Mehta, Maria Stephan, Uma R. Kotagal

Research output: Contribution to journalArticlepeer-review

109 Scopus citations


Background/Purpose: In the pediatric population, appendicitis remains the most common surgical emergency encountered. The purpose of this study was to determine the impact of an evidence-based clinical pathway for acute appendicitis on patient care as well as hospital and home care costs at the authors' pediatric institution. Methods: A prospective evaluation was conducted of an appendicitis clinical pathway (June 1996 through November 1996) compared with historical control patients (June 1994 through November 1994) not cared for by the pathway. Results: Data (average ± SD) for 120 pathway (P) patients were compared with 122 control (C) patients. Age (11.5 ± 3.6 years for C v 11.2 ± 3.9 years for P), rates of negative appendectomy (12.3% for C v 9.2% for P) and perforation (26.2% for C v 18.3% for P) were similar. Pathway patients with nonperforated appendicitis were more often discharged from the hospital within 24 hours (48% for C v 67% for P; P = .014) with lower hospital costs ($4,095 ± $1,280 for C v $3,638 ± $1,633 for P; P = .001). Pathway patients with perforated appendicitis had shorter hospitalization (185.2 ± 59 hours for C v 113 ± 44 hours for P; P= .0001) and lower hospital COSTS ($11,175 ± $3,893 for C v$7,823 ± $2,366 for P; P = .0001). Conclusion: An evidence-based appendicitis pathway decreased duration of hospitalization and cost without adversely affecting diagnosis or therapy. Clinical pathways for surgical diagnoses may prove useful as a means to minimize costs without compromising patient care.

Original languageEnglish
Pages (from-to)1371-1375
Number of pages5
JournalJournal of Pediatric Surgery
Issue number9
StatePublished - Sep 1998


  • Appendicitis
  • Clinical pathway
  • Cost
  • Guidelines
  • Managed care


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