Utsav M Patwardhan, Anastasia Kahan, R Scott Eldredge, Katie W Russell, Justin Lee, Scott S Short, Benjamin Padilla, Sarah B Cairo, Shannon N Acker, Aaron R Jensen, Lorraine I Kelley-Quon, David H Rothstein, Elizabeth A Fialkowski, Stephanie D Chao, Lauren Gillory, Samir Pandya, Jose Diaz-Miron, Romeo C Ignacio
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引用次数: 0
Abstract
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.
期刊介绍：
The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
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