Impact of a Pediatric Appendicitis Clinical Pathway on Offering Non-operative Management

BackgroundAppendicitis in children can be treated with operative management (OM) or non-operative management (NOM) depending on patient risk factors. Our goal was to evaluate for differences in being offered NOM before and after the implementation of a standardized clinical pathway among patients of different demographic backgrounds.MethodsThis was a single center retrospective study of patients under the age of 18 years with appendicitis. Univariate regression was used to assess for associations between demographic factors and patients who were offered NOM.ResultsThere were 730 unique patient encounters for appendicitis during the study period. Qualified patients had significantly increased odds of being offered NOM in the post-pathway period than in the pre-pathway period (OR = 2.21, 95^th CI 1.28-3.82). In the post-pathway period, Hispanic/Latino patients (OR = 0.47, 95^th CI 0.28-0.78) and patients in the 4^th social vulnerability index quartile (OR = 0.46, 95^th CI 0.23-0.94) had decreased odds of being offered NOM. Patients with private insurance (OR = 2.25, 95^th CI 1.33-3.79) had increased odds of being offered NOM. When restricted to patients who qualified for NOM, female patients (OR = 2.66, 95^th CI 1.02-6.93) and patients with private insurance (OR = 3.26 95^th CI 1.31-8.15) were more likely to be offered NOM.ConclusionA clinical pathway for appendicitis increased the odds that qualified patients were offered NOM. However, differences in who was offered NOM based on demographic features were seen. More research on the effect of clinical pathways and factors impacting differential care is needed.