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Comparison of Postoperative Antibiotic Protocols for Pediatric Complicated Appendicitis: A Western Pediatric Surgery
Utsav M Patwardhan1, Anastasia Kahan2, R Scott Eldredge3
1Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA, USA.
Insights
Antibiotic duration for pediatric complicated appendicitis did not affect surgical site infections or readmissions. However, longer antibiotic courses were linked to increased post-discharge drainage, suggesting shorter durations may be beneficial.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Clinical Outcomes Research
Background:
- Consensus is lacking on optimal postoperative antibiotic duration for complicated appendicitis in children.
- Current practices often rely on white blood cell count normalization or fixed treatment durations.
- Varied antibiotic protocols may influence patient outcomes.
Purpose of the Study:
- To compare clinical outcomes associated with different postoperative antibiotic protocols for pediatric complicated appendicitis.
- To evaluate the impact of antibiotic duration on surgical site infections, readmissions, and other complications.
Main Methods:
- Retrospective cohort analysis of 1342 pediatric patients (<18 years) undergoing laparoscopic appendectomy for complicated appendicitis (2021-2023).
- Data from nine children's hospitals using the National Surgical Quality Improvement Program Pediatric (NSQIP-P) database.
- Patients grouped by discharge antibiotic protocols: no discharge antibiotics, antibiotics for elevated WBC, antibiotics to meet minimum duration, or routine discharge antibiotics.
Main Results:
- No significant differences in surgical site infection (5.7-9.8%), ED visits (9.0-15.6%), or 30-day readmissions (2.9-7.6%) among groups.
- Highest median length of stay (5 days) and post-discharge percutaneous drainage rate (9.4%) observed in the group with standardized minimum antibiotic duration.
- Patient demographics (age, BMI) were similar across groups.
Conclusions:
- Discharge antibiotic protocols for pediatric complicated appendicitis did not impact SSI or readmission rates.
- Protocolized, extended discharge antibiotics were associated with a higher incidence of post-discharge drainage.
- Findings suggest an opportunity to reduce unnecessary blood draws and prolonged antibiotic use.
Background:
There is no consensus on the appropriate duration of postoperative antibiotics for complicated appendicitis in children. Commonly used antibiotic endpoints include normalization of white blood cell count (WBC) or completion of a minimum number of prespecified treatment days. We compared clinical outcomes resulting from varying postoperative antibiotic protocols for complicated appendicitis in children.
Methods:
National Surgical Quality Improvement Program Pediatric (NSQIP-P) data from nine children's hospitals was used to identify a retrospective cohort of children (<18 years) who underwent laparoscopic appendectomy from 2021 to 2023 with intraoperative findings of complicated appendicitis. Participating hospitals were classified into four groups based on discharge protocol: 1) no discharge antibiotics, 2) oral antibiotics for elevated WBC on the day of discharge, 3) oral antibiotics to complete a minimum number of total antibiotic days, and 4) routine discharge antibiotics regardless of inpatient antibiotic duration. Univariate analysis was completed between groups.
Results:
We identified 1342 patients with complicated appendicitis who underwent laparoscopic appendectomy. Patients were similar by age and BMI. Median length of stay (5 days) and rate of post-discharge percutaneous drainage (9.4 %) were highest at the center with a standardized minimum duration of discharge antibiotics. There were no statistical differences among treatment groups for surgical site infection (5.7-9.8 %), emergency department visits (9.0-15.6 %), or readmissions within 30 days (2.9-7.6 %).
Conclusion:
The incidence of SSI and readmission following appendectomy did not differ based on the discharge antibiotic protocol, however, the incidence of post-discharge drainage was highest in the center with protocolized discharge antibiotics. These findings highlight an opportunity to minimize unnecessary blood draws and extended postoperative antibiotics.
Level Of Evidence:
III.
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