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In an attempt to reduce variation in management of children with suspected or confirmed complicated appendicitis, a multidisciplinary group at an academic children's hospital developed a comprehensive clinical practice guideline for pediatric surgeons. Among the recommendations:
Early laparoscopic appendectomy, with placement of a closed-suction drain if abscess is present
Administration of piperacillin-tazobactam before and after surgery, with transition to oral ciprofloxacin/metronidazole
No check of white blood cell count after surgery
Computed tomography (CT) scan 7 days after surgery for patients not improving
Investigators compared outcomes between 191 patients treated during the 30 months before the guideline was implemented and 122 patie…