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Impact of postoperative antibiotics on outcomes for nonperforated appendicitis: A propensity score-matched
Ji Hyeong Song1, Song-Yi Kim2, Youn Ju Lee2
1Department of Surgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea.
Background:
The use of postoperative antibiotics in patients with nonperforated appendicitis remains controversial, with limited evidence supporting routine administration. However, certain intraoperative findings, such as gangrenous, suppurative, or exudative, may increase the risk of infectious complications. This study evaluated the impact of postoperative antibiotics on infectious complications after laparoscopic appendectomy for nonperforated appendicitis with gangrenous, suppurative, or exudative findings.
Methods:
We retrospectively reviewed the records of patients who underwent laparoscopic appendectomies between July 2020 and December 2022. Patients younger than 18 years, those with perforated appendicitis, and those without gangrenous, suppurative, or exudative findings were excluded. All patients received preoperative antibiotics and were divided into 2 groups on the basis of postoperative antibiotic use. Propensity score matching was performed to adjust for differences in baseline characteristics. The correlation between postoperative antibiotic use and infectious complications for each surgeon was analyzed.
Results:
A total of 367 adult patients with gangrenous, suppurative, or exudative findings were analyzed. After 1:1 propensity score matching, there were 119 patients in each group, with no differences in characteristics or outcomes between the 2 groups. Gangrene was identified as an independent variable affecting infectious complications (P = .020). Postoperative antibiotic use did not significantly reduce the incidence of infectious complications (11.8% vs 12.6%; P = .843). Although the surgeon-specific rate of postoperative antibiotic use varied, it did not correlate with the incidence of infectious complications (Spearman ρ -0.100; P = .873).
Conclusion:
Postoperative antibiotic use did not prevent infectious complications in nonperforated appendicitis with gangrenous, suppurative, or exudative findings but may be helpful in cases of gangrene.
Insights
Postoperative antibiotics did not prevent infectious complications in nonperforated appendicitis with gangrenous, suppurative, or exudative findings. Gangrene may benefit from their use, but routine administration is not recommended.
Area of Science:
- Surgery
- Infectious Diseases
- Clinical Medicine
Background:
- The role of postoperative antibiotics in nonperforated appendicitis is debated.
- Intraoperative findings like gangrene may increase complication risks.
- This study examines antibiotic impact on laparoscopic appendectomy complications.
Purpose of the Study:
- To evaluate the effect of postoperative antibiotics on infectious complications.
- To analyze outcomes in nonperforated appendicitis with specific intraoperative findings.
- To assess the correlation between antibiotic use and surgeon practices.
Main Methods:
- Retrospective review of laparoscopic appendectomies (July 2020-December 2022).
- Inclusion criteria: adult patients with gangrenous, suppurative, or exudative findings; exclusion of perforated appendicitis.
- Propensity score matching used to compare postoperative antibiotic use versus no use.
Main Results:
- Gangrene independently predicted infectious complications (P=.020).
- Postoperative antibiotics did not significantly reduce infectious complications (11.8% vs 12.6%, P=.843).
- Surgeon antibiotic use rates varied but did not correlate with complication incidence (Spearman ρ -0.100, P=.873).
Conclusions:
- Postoperative antibiotics are not proven to prevent infectious complications in nonperforated appendicitis with gangrenous, suppurative, or exudative findings.
- Antibiotic use may be beneficial specifically in cases involving gangrene.
- Routine postoperative antibiotic administration is not supported by these findings.
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