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Are Postoperative Intravenous Antibiotics Indicated After Laparoscopic Appendicectomy for Simple Appendicitis? A
Nicole Mennie1, Gayathri Panabokke1, Annette Chang1
1Department of Pediatric Surgery, Urology & Surgical Simulation, Monash Children's Hospital, Melbourne, Australia.
Insights
Postoperative antibiotics significantly reduced wound infections in children undergoing appendectomy for simple appendicitis. This study suggests antibiotics are beneficial for simple appendicitis cases.
Area of Science:
- Pediatric Surgery
- Infectious Disease Management
- Clinical Trials
Background:
- Limited evidence exists regarding the efficacy of postoperative antibiotics for simple appendicitis in pediatric patients.
- Laparoscopic appendicectomy is a common procedure in children.
Purpose of the Study:
- To investigate the effectiveness of postoperative antibiotics in reducing surgical site infections after laparoscopic appendicectomy for simple appendicitis in children.
- To evaluate the incidence of wound infection and intra-abdominal abscess formation.
Main Methods:
- A prospective, double-blinded, randomized controlled trial was conducted.
- Pediatric patients (≤16 years) undergoing appendicectomy were randomized to receive either placebo or two postoperative intravenous doses of antibiotics.
- Outcomes measured included wound infection and intra-abdominal abscess formation.
Main Results:
- A total of 243 patients were included in the final analysis (122 placebo, 121 antibiotics).
- A significant reduction in wound infections was observed in the antibiotic group (0.8%) compared to the placebo group (6.6%), P = 0.01.
- No intra-abdominal abscesses were reported in either group.
Conclusions:
- Two postoperative intravenous doses of antibiotics significantly decrease wound infection rates in children with simple appendicitis.
- Postoperative antibiotic administration is beneficial in managing simple appendicitis cases following laparoscopic appendicectomy.
Background:
There is limited evidence for the use of postoperative antibiotics for simple appendicitis (SA) in children. Our aim was to conduct a prospective double-blinded randomized controlled trial to investigate this after a laparoscopic appendicectomy.
Methods:
Following ethical approval, children (≤16 years) undergoing appendicectomy were recruited at a single institution. Patients were randomized intraoperatively to receive either 2 postoperative intravenous doses of placebo or antibiotics (Abx). All patients received a dose of Abx at induction of anesthesia. Primary outcome was the incidence of postoperative wound infection (WI), and secondary outcome was the incidence of intra-abdominal abscess formation. Data are reported as number of cases (%), median (range), relative risk, and analyzed using Mann Whitney U test, Chi-square test, as appropriate, a P-value ≤0.05 was considered significant.
Results:
A total of 304 patients were randomized. Sixty-one were subsequently excluded due to protocol violations or recruitment errors; therefore, 243 were included in the final analysis. One hundred twenty-two patients received placebo and 121 Intravenous Abx. There was no difference between the sex (50F/72 M vs 47F/74 M, P = 0.8), median age (12.4 vs 12.2 years, P = 0.5), and postoperative length of stay in a hospital (27.2 vs 25.6 hours, P = 0.7). There was also no difference in the preoperative blood results. A total of 9 WIs occurred: 8/122 (6.6%) placebo versus 1/121 (0.8%) Abx, P = 0.01 [relative risk for WI 7.9 (95% confidence interval: 1.0-62.4)]. There were no intra-abdominal abscess in either groups.
Conclusions:
This prospective randomized double blinded randomized controlled trial has revealed a significant decrease in WI rates by giving 2 postoperative intravenous doses of Abx, suggesting postoperative Abx are of benefit in SA.
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