Gavin Nair, current junior surgical registrar in Royal Adelaide Hospital formally of Department of general surgery, Flinders Medical Centre, Adelaide, South Australia. Completed undergraduate MBBS from Monash University.
Reduced Duration of Intravenous Antibiotics after Complicated Appendicitis is Safe and Effective
Background Intravenous antibiotic (IVAB) prophylaxis of 3 to 7 days is recommended after surgery in patients with complicated appendicitis. However, there is no consensus about its duration and shorter courses may be as effective to prevent infectious complications. The aim of this study was to analyze the duration and efficacy of postoperative IVAB usage in our hospital.
Methods We analyzed our prospectively collected database for patients who had undergone an appendicectomy for a complicated appendicitis in our hospital over a 5-year period (2013-2017). Patient and treatment characteristics, histopathology diagnosis and postoperative outcomes were analyzed.
Results A total of 2011 patients had surgery for appendicitis in the study period, including 226 (11.2%) patients with a complicated appendicitis. The mean duration of IVAB in this group was 3.4 days (SD 2.3, Range 1 day to 10 days) and the length of hospital stay was 4.8 days (SD 3.6 Range 2 days to 31 days). Fifteen (6.6%) patients with complicated appendicitis were re-admitted. One hundred and forty-one patients (62.4%) received IVAB for 3 days or less while 85 patients (37.6%) received IVAB for 4 or more days, with similar postoperative complications (3.5% vs 8.2%; OR 0.40; CI 0.12-1.3; p=0.13) and readmission rates (7.3% vs 4.7%; OR 1.71; CI 0.52-5.5; p=0.42) between groups. The median hospital stay was 2.7days (SD 1.6) compared to 6.7days (SD 3.5) in those that received 4 days or more.
Conclusion There is a wide range in the days of IVAB after surgery of a complicated appendicitis. Our current data suggest that a 3-day IVAB regime is equally effective and safe as longer durations of IVAB, resulting in a shorter hospital stay and healthcare costs.