Outcomes of Different Hospital Discharge Antibiotic Regimens After Perforated Appendectomy

Abstract

Background

Acute appendicitis is one of the most common problems addressed by pediatric surgeons and overall, there are high rates of perforation upon initial hospital presentation. Optimal post-appendectomy hospital discharge antibiotic management for perforated appendicitis is controversial in current pediatric surgical literature.

Methods

This is a single institution retrospective review of patients’ that underwent laparoscopic appendectomy for perforated appendicitis at AdventHealth for Children - Orlando between July 1^st 2021 and June 30^th 2023. Three different discharge antibiotic regimens were analyzed: no antibiotics prescribed at discharge, antibiotics prescribed between 1 and 7 days at discharge, and antibiotics prescribed for more than 8 days at discharge. Outcome measures included 30- and 60-day readmission rates, postoperative infection, postoperative complications, and re-interventions.

Results

In total, data from 106 patients with an average age of 11.2 years was analyzed. Our population included 63 males (59.4%) and 43 females (40.6%). Between our three treatment groups, there were no statistically significant differences in preoperative maximum temperature (T-max), preoperative white blood cell count (WBC), discharge WBC, or hospital length of stay. There were no statistically significant differences of 30- and 60-day readmission rates, postoperative infection, postoperative complications, or re-interventions. Additional analysis comparing patients with no antibiotics at discharge to all patients prescribed antibiotics at discharge showed there was no significant difference of 30- and 60-day readmission rates, postoperative infection, postoperative complications, or re-interventions but there was a significantly longer hospital length of stay for patients prescribed antibiotics at discharge.

Conclusion

There is no difference in postoperative outcomes after surgical intervention for perforated appendicitis with or without antibiotics at hospital discharge. Elimination of postoperative antibiotic use could result in better antibiotic stewardship, decreased patient cost, and decreased hospital length of stay. Further research with a randomized, prospective trial is warranted.