Clinical Practice Guidelines for Pediatric Complicated Appendicitis: The Value in Discipline.

Abstract

Appendicitis has been written about since surgical journals began. There have been randomized trials about when to operate, how to operate (open vs laparoscopic), what antibiotics to use, whether to use drains or not, or, as reported in JAMA Surgery, whether to let the patient choose to be operated on. Frankly, one would think that after almost 100 years since the development of anesthesia and antibiotics, we would have at least figured out appendicitis. It appears that we have not. If the standing-room-only attendance at the 2015 plenary session of the American College of Surgeons meeting is an indication, surgeons continue to seek information about the best treatment scheme. Although the article by Willis et al1 does not completely illuminate the path (and, in full disclosure, I must confess myWest Coast bias against the routine use of drains), it does demonstrate that no matter what technique is used, if everyone in the hospital uses the same protocol and pays attention to following the plan (clinical practice guidelines), the patients in the hospital will do better than they did before. It reminds me of dieting—I always do better when I actually stick to theplan! It’s the season for resolutions; let’smake a plan and stick to it. Both patients andphysicianswill be better for it.