Postoperative antibiotics do little to improve outcomes in paediatric gangrenous appendicitis

In children who have nonperforated appendicitis with gangrenous, suppurative, and exudative (GSE) findings, the use of antibiotics following appendectomy does not lower the risk of surgical site infection (SSI), as shown in a study.

Researchers reviewed the medical records of 958 children (mean age 10.7 years, 59.2 percent male) with nonperforated appendicitis with GSE findings who underwent appendectomy. They assessed the effect of the continuation of antibiotics after appendectomy on the rate of 30-day postoperative SSI, including both incisional and organ space infections.

Complementary hospital and patient-level analyses were conducted. The hospital-level analysis was used to explore the correlation between postoperative antibiotic use and observed-to-expected SSI rate ratios, while the patient-level analysis was used to compare outcomes.

The hospital-level analysis included 958 children (mean age 10.7 years, 59.2 percent male), among whom 573 (59.8 percent) received postoperative antibiotics. Postoperative antibiotic use was not associated with hospital-level observed-to-expected SSI ratios when analysed by either overall rate of use (hospital median, 53.6 percent; p=0.71) or by postoperative antibiotic duration (hospital median, 1 day; p=0.79).

Meanwhile, the propensity-matched patient-level analysis included 404 children. The rates of SSI were similar between those who received postoperative antibiotics and those who did not (1.5 percent vs 2.0 percent; odds ratio, 0.75, 95 percent confidence interval [CI], 0.16–3.39; p=0.70).