Postoperative antibiotics do not improve nonperforated appendicitis outcomes in children
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Key takeaways:
- Results showed an overall postoperative surgical site infection rate of 2.8%, ranging from 0% to 8.6% across hospitals.
- No association was found between postoperative antibiotic use and risk for infection.
Postoperative antibiotic use did not improve rates of surgical site infection among pediatric patients with nonperforated appendicitis and gangrenous, suppurative or exudative findings, according to data in JAMA Surgery.
“Appendicitis is the most common abdominal surgical emergency in children, accounting for the greatest relative burden of surgical site infections (SSIs) in pediatric surgery,” Shannon L. Cramm, MD, MPH, a clinical fellow in surgery at Massachusetts General Hospital, and colleagues wrote. “When considering the public health implications of SSIs and antimicrobial resistance, optimizing SSI prevention while minimizing antibiotic overuse should be considered a high priority goal within pediatric surgery.”
They added: “Whether continuation of antibiotics postoperatively is beneficial in children with nonperforated appendicitis associated with gangrenous, suppurative or exudative findings remains a controversial topic.”
In a retrospective cohort study, Cramm and colleagues used data from the American College of Surgeons’ National Surgical Quality Improvement Program-Pediatric Appendectomy Procedure Targeted Variables to compare rates of SSI among children with nonperforated appendicitis and gangrenous, suppurative or exudative (GSE) findings who underwent appendectomy between July 2015 and June 2020.
Of 958 children (mean age, 10.7 years; 59.2% boys) from 16 hospitals included in analysis, 59.8% received postoperative antibiotics and 33.3% were prescribed antibiotics at the time of discharge. The median duration of postoperative antibiotic use was 1 day and ranged from 0 to 7 days across hospitals.
Results demonstrated an overall postoperative SSI rate of 2.8% (incisional SSI rate = 1.5%; organ space infection rate = 1.4%), which ranged from 0% to 8.6% across hospitals. Hospital-level observed-to-expected SSI rate ratios ranged from 0 to 1.28, with no correlation between hospital-level rates of SSI and postoperative antibiotic use rates (hospital median = 53.6%) or mean postoperative antibiotic duration (hospital median = 1 day).
Among 404 children in a propensity-matched cohort, those who received postoperative antibiotic use had “similar rates” of SSI compared with children who did not receive postoperative antibiotics (1.5% vs. 2%; OR = 0.75; 95% CI, 0.16-3.39). There also was no significant difference between antibiotic use when patients were grouped by incisional (1.5% vs. 1%) vs. organ space (0% vs. 1%) SSI.
Further, researchers reported no association between hospital-level observed-to-expected ratios of abdominal imaging or hospital revisits and postoperative antibiotic use.
“The results of this cohort study suggest that postoperative antibiotics should not be used in children with nonperforated appendicitis with GSE findings,” Cramm and colleagues concluded. “When considering the potential magnitude of national practice variation in the use of postoperative antibiotics that can be extrapolated from these data, elimination of postoperative antibiotic use in children with nonperforated appendicitis with GSE findings could substantially improve antimicrobial stewardship in the management of pediatric appendicitis.”
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