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Postoperative antibiotics correlate with worse outcomes after appendectomy for nonperforated appendicitis
Brian A Coakley1, Eric S Sussman, Theodore S Wolfson
1Department of Surgery, The Mount Sinai Medical Center, New York, NY, USA.
Background:
Acute appendicitis remains the most common cause of acute abdominal pain necessitating operative intervention. Although postoperative antibiotics are universally used for perforated appendicitis, no consensus exists on whether postoperative antibiotics are beneficial for preventing surgical site infections (SSIs) in nonperforated cases. We set out to determine how postoperative antibiotic therapy affects outcomes after appendectomy for nonperforated appendicitis.
Study Design:
The medical records of 1,000 patients undergoing appendectomy for nonperforated appendicitis at The Mount Sinai Medical Center from January 2005 through July 2010 were retrospectively reviewed.
Results:
In total, 728 cases contained sufficient follow-up data for analysis; 334 of these patients received postoperative antibiotics and 394 did not. There were no significant differences in patient demographics, medical comorbidities, American Society of Anesthesiologists (ASA) class, admission temperature, preoperative antibiotic treatment, operating room time, estimated blood loss, appendiceal diameter, or intraoperative transfusion between the two groups, although WBC was higher for patients receiving postoperative antibiotics (12.3 vs 14 cells/mm(3), p = 0.001). Postoperative antibiotics did not alter the incidence of superficial SSIs, deep SSIs, or organ space SSIs (all p = 0.1), but did correlate with higher rates of Clostridium difficile infection (p = 0.02), urinary tract infection (p = 0.05), postoperative diarrhea (p < 0.001), and longer length of stay (LOS) (1.1 vs 2.4 days, p < 0.001). Patients receiving postoperative antibiotics also showed trends toward higher readmission and reoperation rates (both p = 0.06).
Conclusions:
Postoperative antibiotic treatment for nonperforated appendicitis did not reduce infectious complications and prolonged LOS while increasing postoperative morbidity. Therefore, postoperative antibiotics likely increase the treatment cost for nonperforated appendicitis while not adding an appreciable clinical benefit and, in some cases, actually worsening outcomes.
Insights
Postoperative antibiotics for nonperforated appendicitis do not prevent surgical site infections. This practice prolonged hospital stays and increased complications, suggesting it offers no clinical benefit and may worsen outcomes.
Area of Science:
- General Surgery
- Infectious Diseases
- Clinical Outcomes
Background:
- Acute appendicitis is a common cause of acute abdominal pain requiring surgery.
- Postoperative antibiotics are standard for perforated appendicitis, but their necessity for nonperforated cases is debated.
- This study investigates the impact of postoperative antibiotics on surgical site infections (SSIs) in nonperforated appendicitis.
Purpose of the Study:
- To determine if postoperative antibiotic therapy impacts outcomes after appendectomy for nonperforated appendicitis.
- To assess the effect of postoperative antibiotics on infectious complications and length of stay.
- To evaluate the overall clinical and economic benefit of postoperative antibiotics in this patient population.
Main Methods:
- Retrospective review of 1,000 patient records undergoing appendectomy for nonperforated appendicitis.
- Analysis of 728 cases with sufficient follow-up data, comparing outcomes between patients who received postoperative antibiotics (334) and those who did not (394).
- Comparison of patient demographics, comorbidities, operative details, and postoperative outcomes including SSIs, Clostridium difficile infection, urinary tract infection, and length of stay.
Main Results:
- Postoperative antibiotics did not reduce the incidence of superficial, deep, or organ space SSIs.
- Patients receiving postoperative antibiotics had higher rates of Clostridium difficile infection, urinary tract infection, and postoperative diarrhea.
- A significantly longer length of stay (LOS) was observed in patients who received postoperative antibiotics (2.4 days vs. 1.1 days).
- Trends toward higher readmission and reoperation rates were noted in the antibiotic group.
Conclusions:
- Postoperative antibiotic treatment for nonperforated appendicitis does not decrease infectious complications.
- This treatment strategy prolongs LOS and increases postoperative morbidity, including C. difficile infections and diarrhea.
- Current evidence suggests that postoperative antibiotics for nonperforated appendicitis increase treatment costs without providing clinical benefit and may lead to adverse outcomes.
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