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Antibiotics versus placebo for prevention of postoperative infection after appendicectomy
B R Andersen1, F L Kallehave, H K Andersen
1Department of Surgical Gastroenterology K, H:S Bispebjerg Hospital, 23 Bispebjerg Bakke, Copenhagen NV, Denmark, DK 2400. cccg@cccg.dk
Background:
Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. The cause of appendicitis is unclear and the mechanism of pathogenesis continues to be debated. Despite improved asepsis and surgical techniques, postoperative complications, such as wound infection and intraabdominal abscess, still account for a significant morbidity. Several studies implicate that postoperative infections are reduced by administration of antimicrobial regimes.
Objectives:
The objective of this review is to compare the use of antibiotics with placebo or no treatment in patients undergoing appendectomy. Will these patients benefit from antimicrobial prophylaxis? The outcomes are described according to the nature of the appendix, as either simple appendicitis (including the non-infectious stage) and complicated appendicitis. This review do not attempt to compare the effect of different regimens, a clinical question that is addressed in another review undertaken by this Group (CCCG).
Search Strategy:
We searched The Cochrane Controlled Trials Register (Cochrane Library 2000 issue 4), Medline (January 1966 to September 2000), Embase and the Cochrane Colorectal Cancer Group specialised register (September 2000). In addition we manually searched the reference lists of the primary identified trials.
Selection Criteria:
Randomised Controlled Trials (RCT) and Controlled Clinical Trials (CCT) in which any antibiotic regime were compared to placebo in patients suspected of having appendicitis undergoing appendectomy were evaluated. Both studies on children and adults were reviewed. The outcome measures of the studies were either wound infection, intraabdominal abscess, length of stay in hospital or mortality.
Data Collection And Analysis:
Eligibility and trial quality were assessed, recorded and cross-checked by to reviewers.
Main Results:
Forty-four studies including 9298 patients were included in this review. The overall result is that use of antibiotics is superior to placebo for the outcome wound infection and intraabdominal abscess, with no apparent difference in the nature of the removed appendix. Studies exclusively on children and studies examining topical application reported results in favour to the above although the results were not significant.
Reviewer'S Conclusions:
Antibiotic prophylaxis is effective in the prevention of postoperative complications in appendectomised patients, whether the administration are given pre-, per- and post-operatively and could be considered for routine in emergency appendectomies.
Insights
Antibiotic prophylaxis significantly reduces postoperative complications like wound infections and intraabdominal abscesses in patients undergoing appendectomy. This treatment is effective and should be considered for routine use in emergency appendectomies.
Area of Science:
- Surgery
- Infectious Diseases
- Clinical Trials
Background:
- Appendicitis is a common cause of acute abdominal pain requiring surgery.
- Postoperative complications, including wound infection and intraabdominal abscess, remain significant despite advances in surgical techniques.
- Antimicrobial administration is suggested to reduce postoperative infections.
Purpose of the Study:
- To compare the efficacy of antibiotics versus placebo or no treatment in preventing complications after appendectomy.
- To determine if antimicrobial prophylaxis benefits patients undergoing appendectomy for simple or complicated appendicitis.
Main Methods:
- Systematic review and meta-analysis of Randomized Controlled Trials (RCTs) and Controlled Clinical Trials (CCTs).
- Searched major databases including Cochrane Library, Medline, and Embase.
- Included studies comparing antibiotic regimens to placebo in adult and pediatric patients undergoing appendectomy, assessing outcomes like wound infection, intraabdominal abscess, hospital stay, and mortality.
Main Results:
- Analysis of 44 studies involving 9298 patients.
- Antibiotics demonstrated superiority over placebo in reducing wound infections and intraabdominal abscesses.
- No significant difference was observed based on the nature of the appendix; however, studies in children and those using topical antibiotics showed favorable trends.
Conclusions:
- Antibiotic prophylaxis is effective in preventing postoperative complications following appendectomy.
- Prophylactic antibiotics can be administered pre-, peri-, and post-operatively.
- Routine use of antibiotic prophylaxis in emergency appendectomies is recommended.