Cessation of Antibiotics for Complicated Appendicitis at Discharge | Single Center | NSQIP data | Jan 2015 - May 2022 | 2 Cohorts: | Home antibiotics (n=185) | No home antibiotics (n=121) | Children undergoing appendectomy for complicated appendicitis. | Home antibiotics - (83% discharged w/ antibiotics) | No home antibiotics - (8.3% discharged w/ antibiotics) | No significant differences in: | Deep organ space infection (7% vs. 7.4%, p = 1.0) | Length of stay (LOS) (4.5 days vs. 3.95, p = 0.32) | C. diff colitis, ER visits, post-op CT imaging | Conclusion: Eliminating home antibiotic therapy showed no differences in deep organ space infections and LOS, so its discontinuation is recommended at discharge following surgery for complicated appendicitis. | https://pubmed.ncbi.nlm.nih.gov/37858398/ | @StayCurrentMD | Source: Russell KW et. al. | Division of Pediatric Surgery & Pediatric Infectious Diseases, University of Utah, Salt Lake City, UT, USA | @EmGooteMD | Cincinnati Children's | Journal of Pediatric Surgery
Cessation of Antibiotics for Complicated Appendicitis at Discharge Does Not Increase Risk of Post-operative Infection
Infographic · Jul 2024 · 1 min read
In brief
In brief
Retrospective study of 306 pediatric patients found that discontinuing home antibiotics after complicated appendectomy did not increase postoperative deep organ space infections (7% vs 7.4%) or other complications. Findings challenge routine home antibiotic prescribing and support antibiotic stewardship in this population.
- Stopping home antibiotics after complicated appendicitis surgery did not increase postoperative infection rates (7% vs 7.4%, p=1.0)
- Length of stay remained unchanged when eliminating discharge antibiotics (4.5 vs 3.95 days, p=0.32)
- Response-based inpatient IV antibiotics until clinical improvement may be sufficient without home antibiotic continuation
- Home antibiotic cessation did not increase readmissions, ER visits, or need for postoperative imaging
- Current practice of routine discharge antibiotics for complicated appendicitis should be reconsidered to reduce unnecessary exposure
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with a hospital building illustration on the left and a child figure on the right. Key statistics are highlighted in contrasting colors (teal for home antibiotics cohort, green for no home antibiotics cohort). A cartoon appendix character appears near the bottom, and the conclusion is presented in a yellow banner at the base.
Katie W. Russell, David E. Skarda, Trahern W. Jones, Douglas C. Barnhart, Scott S. Short
Purpose: The utilization of home antibiotic therapy following surgery for complicated pediatric appendicitis is highly variable. In 2019, we stopped home antibiotic therapy in this cohort at our institution. We sought to evaluate our outcomes following this protocol change.
Methods: We queried our institutional NSQIP Pediatrics data for all children undergoing appendectomy for complicated appendicitis between January 2015 and May 2022. We identified two cohorts: those discharged with home antibiotics (1/1/15-4/30/19) and those discharged with no home antibiotics (5/1/19-4/30/22). Both groups were treated with response based parenteral antibiotics while hospitalized and discharged when clinically well. Our primary outcome was postoperative deep organ space infection requiring intervention (drainage, aspiration, reoperation, or antibiotics). Secondary outcomes included length of stay, superficial site infection, Clostridium difficile colitis, ER visits, post-operative CT imaging, and readmission.
Results: There were 185 patients in the home antibiotic group (83% discharged with antibiotics) and 121 patients in the no home antibiotic group (8.3% discharged with antibiotics). There were no significant differences in deep organ space infection requiring intervention (7% vs. 7.4%, p = 1.0). Our length of stay was not different (4.5 days vs. 3.95 days, p = 0.32), nor were other secondary outcomes or patient characteristics. All patients had documented follow-up.
Conclusions: We did not identify differences in deep organ space infections, length of stay or other events after eliminating home antibiotic therapy in our complicated appendicitis cohort. The use of home antibiotics following surgery for complicated appendicitis should be reconsidered.