Splitting hairs and challenging guidelines: Defining the role of perioperative antibiotics in pediatric appendicitis patients

Case-control study of 1,549 pediatric appendicitis patients found optimal preoperative antibiotic timing of 18-70 minutes before incision reduced SSI risk, while postoperative antibiotics showed no benefit in uncomplicated cases. For complicated appendicitis, physiologic recovery within 6 days predicted lower SSI rates (8.8% vs 49.3%).