Related Experiment Videos
Antibiotics versus placebo for prevention of postoperative infection after appendectomy
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 apparant 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 wound infections and intraabdominal abscesses in patients undergoing appendectomy. This review supports routine use of antibiotics for emergency appendectomies to prevent postoperative complications.
Area of Science:
- Medical research
- Surgical outcomes
- Infectious disease
Background:
- Appendicitis is a leading cause of acute abdominal pain requiring surgery.
- Postoperative complications like wound infection and abscess remain significant challenges.
- Antimicrobial administration is suggested to reduce postoperative infections.
Purpose of the Study:
- To compare antibiotic use versus placebo or no treatment in appendectomy patients.
- To determine if antimicrobial prophylaxis benefits patients undergoing appendectomy.
- To analyze outcomes based on appendicitis severity (simple vs. complicated).
Main Methods:
- Searched Cochrane Controlled Trials Register, Medline, Embase, and specialized registers.
- Included Randomized Controlled Trials (RCTs) and Controlled Clinical Trials (CCTs).
- Evaluated outcomes including wound infection, intraabdominal abscess, hospital stay, and mortality.
Main Results:
- 44 studies with 9298 patients were reviewed.
- Antibiotics proved superior to placebo in reducing wound infection and intraabdominal abscess.
- No significant difference was observed in outcomes for children or topical antibiotic application.
Conclusions:
- Antibiotic prophylaxis is effective in preventing postoperative complications after appendectomy.
- Consideration for routine use in emergency appendectomies is recommended.
- Prophylaxis can be administered pre-, peri-, and post-operatively.