Antibiotic Duration Post Appendicitis

This project is being led by Dr. Monica Lopez from Vanderbilt and Dr. Erich Grethel from Dell Children’s.

Our aim is to evaluate the Collaborative cohort antibiotic usage after appendectomy for complex appendicitis, and, following the principles of antibiotic stewardship, to impart judicious antibiotic usage and early discharge of these patients with minimal morbidity.”

Project Overview:

This project was inspired by the findings of the STOP-IT trial in the adult population1. The STOP-IT trial demonstrated that a set duration of 4+/-1 days of antibiotic administration after source control of intra-abdominal infections had similar outcomes to those treated with longer duration antibiotics.  This project’s objective is to substantially reduce the prescribing of oral antibiotics post operatively and at discharge, for our pediatric patients with complex appendicitis. Our balancing measure will be no increase in the rate of SSIs or readmissions in this patient group. Ultimately qualitative interviews may be conducted near project conclusion to collect best practices from good performers and barriers from less good performers. These qualitative findings will be collated into an implementation guide and broadly distributed. Project duration is estimated to be 12-18 months.

Data Collection Requirements and Storage:

The NSQIP-P Targeted Appendicitis SAR currently collects information on antibiotic use post at discharge. The project workgroup will create processes for which variables to collect. This is still under discussion but most likely will be antibiotic prescribed at discharge (yes/no); antibiotic type; number of days of in-house antibiotic use; length of stay (LOS); readmissions and SSIs.  Education around how to download the Data Download Report (DDR) into an Excel spreadsheet with the correct variables selected and all PHI scrubbed; quarterly submission of the cultivated DDR to the DCC with an agreed upon start date; and how to save the report in the NSQIP workstation for ease of future abstraction.

Project Assessment:

The project objective is to assess the efficacy of reducing antibiotic use in this patient population without increasing the incidence of SSIs and readmissions as demonstrated by the STOP-IT trial. The initial set of data submitted will provide a baseline measure of how a participating hospital is performing on antibiotic use in this patient population compared to SSIs and 30-day readmissions. As the project matures, data will be collected at quarterly intervals, analyzed and then shared with participating hospitals. The comparison between antibiotic usage and SSI incidence and readmissions will be displayed using run charts and scatterplots. We hypothesize that reducing antibiotic post op to no more than 4 days post-op will not result in an increase of SSIs and/or readmissions after appropriate source control.

PSQC Antibiotic Duration Protocol

SCR Documents:

Workgroup Members:

Dr. Jeffrey Burford, Pediatric Surgeon, Arkansas Children’s, Little Rock, AR

Dr. Nicole Chandler, Pediatric Surgeon, Nemours Children’s, Orlando, FL

Ms. Kathryn Danko, CSVPM, Dell Children’s, Austin, TX

Raquel Gonzalez, Pediatric Surgeon, Nemours Children’s, Orlando, FL

Dr. Erich Grethel, Pediatric Surgeon, Dell Children’s, Austin, TX

Ms. Laura Jorg, SCR, Dayton Children’s, Dayton, OH

Dr. Rebecca Levorson, Infectious Disease, Inova Children’s, Fairfax, VA

Dr. Monica Lopez, Pediatric Surgeon, Vanderbilt Children’s, Nashville, TN

Dr. Daniel Robie, Pediatric Surgeon, Dayton Children’s, Dayton, OH

Dr. Ruben Rodriguez, Pediatric Surgeon, Texas Children’s, Houston, TX

Ms. Amanda Skaggs, SCR, Dayton Children’s, Dayton, OH

Dr. Regan Williams, Le Bonheur Children’s, Memphis, TN

Dr. Sani Yamout, Pediatric Surgeon, Kaiser Oakland, Oakland, CA

 

 

For additional information, please contact the PSQC Program Manager, Terry Fisher, at terry.fisher@uth.tmc.edu.

 

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