Appendicitis as a model for pediatric surgical quality improvement and standardization

Appendicitis serves as a model for pathway-driven quality improvement (QI) in pediatric surgical care. The high case volume, predictable clinical trajectory, and measurable outcomes associated with acute appendicitis care facilitate identification of unwarranted practice variation and allow standardization to be feasible at scale. Starting in the mid-2010s, several QI initiatives transformed appendicitis management in children. This review highlights four QI efforts in pediatric appendicitis management including the shift of diagnostic imaging from routine computed tomography to ultrasound-first strategies, improved opioid stewardship, de-implementation of low-value practices such as routine total parenteral nutrition utilization, and generation of severity-guided clinical practice guidelines that decreased postoperative antibiotic durations. Across these domains, improvement followed a consistent progression through phases of documented variation, evidence consolidation, structured local implementation, guideline alignment, and eventually sustained monitoring of guideline-based practices. Continued progress will require ongoing development of pediatric-specific evidence, dissemination of evidence-based practices into broader practice settings, and focused efforts to ensure equitable implementation across populations. QI efforts for appendicitis serve as a transferable blueprint for value-based and safety-focused pediatric care, demonstrating that unwarranted variation can be reduced when evidence-based practices are embedded into structured clinical guidelines, process metrics and outcomes are measured transparently, and principles are reinforced through coordinated dissemination.