Acute Appendicitis Pathways: A Systemic Review

Background: Clinical pathways are effective in reducing healthcare cost and standardizing management protocol for diseases and conditions. However, there are no standardized pathways for appendicitis. This study aims to determine whether implementation of a standardized clinical pathway for managing appendicitis may lead to improved patient care. Materials and Methods: We searched for articles published in PubMed, MEDLINE, and Cochrane library between 1974 and 2015. Thirty-seven papers published in English that met inclusion criteria were included and analyzed in this review. A total of 37 studies met inclusion criteria and were analyzed for the purpose of this study. Results: A clear definition for appendicitis pathway was observed in 30 articles. Appendicitis was diagnosed based on clinical and laboratory findings; however, 34% of the studies included radiological investigations. Sixteen studies provided clear definitions for discharge criteria. Time of follow-up (5 - 28 days) was reported in 10 studies. Operative time was the most commonly used outcome measure. The mean length of stay for non-complicated appendicitis was 1.3 days, and 6.26 days for complicated appendicitis. Most of the studies concluded that the accuracy of a clinical pathway for appendicitis diagnosis can be achieved by assessing the incidence of a normal appendix. The mean cost for patient care was $4874.14 (SAR 18,278.03). Conclusion: There was no standardized definition for appendicitis clinical pathway components. Studies suggested that establishing a clinical pathway for appendicitis improves the outcome and minimizes the cost.