Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012

1. Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 Postoperative IV Antibiotic Therapy for Children with Complicated Appendicitis: A Propensity Score-Matched Observational StudyPresenter: Tzu-Chieh Wendy Yu 1. South Auckland Clinical School, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, NEW ZEALAND 2. Starship Children’s Hospital, Auckland District Health Board, NEW ZEALAND 1-1c HRT1215-Session_WENDY_YU_ADHB_NZ

2. KEY PROBLEM Complicated Appendicitis (appendicitis with secondary peritonitis) is the most common intra-abdominal infection in children. Traditional postoperative antibiotic regimes have long fixed arbitrary durations (>4 days) leading to unnecessary hospitalisation. More recent research: “.... limiting antibiotic duration to 3 days is unlikely to increase risks of infectious complications.”

3. AIM OF THIS INNOVATION Overall: To improve inpatient care of children with complicated appendicitis by optimising postoperative intravenous antibiotic therapy More specifically, to reduce length of hospital stay without compromising patient care from inadequate treatment An observational study was conducted to evaluate the efficacy and apparent safety of using a set of clinical criteria to guide duration of postoperative IV antibiotic therapy in children with complicated appendicitis Propensity scores used to match prospectively observed patients [EXPOSURE COHORT] to retrospectively reviewed historical patients [CONTROL COHORT]

4. BASELINE DATA Starship Children’s Hospital, Auckland, New Zealand 47 historical patients, retrospectively reviewed, selected and matching using propensity scores, to form the study CONTROL COHORT All diagnosed with complicated appendicitis and treated with postoperative antibiotics for minimum 5 days Length of stay, and frequency and severity of postoperative complications recorded (see subsequent slides)

5. KEY CHANGES IMPLEMENTED Latest Recommendations: “Duration of antimicrobial therapy for established Intra-abdominal infections be guided by clinical Symptoms and signs of resolving infection.” (Grade B Evidence) Lee et al. J Pediatr Surg. 2010; 45:2181-5. Nadler & Gaines. Surg Infect (Larchmt). 2008; 9:75-83. Solomkin et al. Clin Infect Dis. 2010; 50:133-64.

6. KEY CHANGES IMPLEMENTED Between August 2011 and February 2012, 47 patients diagnosed with complicated appendicitis were prospectively observed and postoperative IV antibiotics were discontinued once the following clinical criteria were satisfied: Must meet all criteria prior to discontinuation of postoperative antibiotics and hospital discharge: 1. Afebrile(Temp < 38.0°C) for 24 hours 2. Tolerating light diet (2 consecutive meals) 3. Pain controlled with oral analgesia 4. Mobilising independently (if ambulatory)

7. OUTCOMES SO FAR LOS and Readmission

8. OUTCOMES SO FARPostoperative Complications

9. LESSONS LEARNT Tailoring duration of postoperative antibiotic therapy for complicated appendicitis to a set of beside clinical parameters shortens LOS without apparent compromise to patient outcomes in children