Compliance with published recommendations for postoperative antibiotic management of children with appendicitis: A...

Area of Science:

• Pediatric Surgery
• Infectious Disease Management
• Clinical Practice Guidelines

Background:

• American Pediatric Surgical Association (APSA) guidelines for postoperative antibiotics in appendicitis were published in 2010.
• Implementation of clinical practice recommendations can be slow, with significant delays.
• This study assessed pediatric surgeon compliance with APSA appendicitis antibiotic guidelines.

Purpose of the Study:

• To measure pediatric surgeon compliance with 2010 APSA recommendations for postoperative antibiotic use in appendicitis.
• To identify the extent of antibiotic overprescription in pediatric appendicitis cases.
• To evaluate the impact of reminders on compliance.

Main Methods:

• Retrospective review of 210 pediatric appendectomy cases (2010 onwards) with Research Ethics Board approval.
• Descriptive analysis of compliance with APSA antibiotic recommendations.
• Kappa statistic used to assess agreement between surgeon and pathologist diagnoses of perforation.

Main Results:

• Compliance with APSA recommendations was low, with 52% of nonperforated and 62% of perforated appendicitis cases receiving excess antibiotics.
• Agreement on perforation status between surgeons and pathologists was good (κ=0.75).
• Despite reminders, significant overprescription of postoperative antibiotics persisted.

Conclusions:

• Pediatric surgeons frequently exceed recommended postoperative antibiotic durations for appendicitis.
• Overtreatment contributes to medication errors, increased length of stay, and higher healthcare costs.
• Intensified implementation programs with ongoing education and monitoring are necessary to improve guideline adherence and reduce antibiotic overuse.