Outcome of Using Clinical Pathway in Laparoscopic Appendicectomy Patients - A Retrograde Analysis

introduction: Appendicitis is a very common illness affecting all age groups of patients. It is the most common abdominal emergency. Open appendicectomy is a traditional method with its attendant complications. With the advent of laparoscopic surgeries, a laparoscopic appendicectomy has become one of the most common performed surgeries today. In many parts of the world, laparoscopic appendicectomy is a day care procedure. Aim: To compare the efficacy of the pathway in appendicitis management in view of hospital stay, readmission rate, and complication rate. Materials and Methods: A retrospective study was conducted in Sri Ramachandra University patients from 2008 to 2013. Comparison between the pathway group (2011-2013) and non-pathway (2008-2010) group was done. The duration of the hospital stay, complication rates, and readmission rate was compared between these two groups. In total of 893 patients, no clinical pathway was applied in 444 numbers of patients and pathway was applied 449 numbers of patients. Based on intraoperative findings both group patients are divided into appendicitis with peritonitis and appendicitis without peritonitis. Results: The comparison between no pathway and pathway groups in the hours of hospital stay duration of appendicitis without peritonitis shows the statistical significance. The comparison between no pathway and pathway groups in the hours of hospital stay duration of with peritonitis shows no statistical significance. There was no difference in view of readmission rate and complication rate in both groups. Conclusion: A standardized clinical pathway for simple appendicitis without peritonitis is very useful to reduce the duration of hospital stay without increase in readmission rate and complication rate. It gives favorable results on patient’s outcome, hospital cost, and professional practice. Further modification of clinical pathway is essential to apply this in appendicitis with peritonitis patients to improve the outcome.