Postoperative antibiotics may not improve outcomes among kids with nonperforated appendicitis with gangrenous, suppurative, or exudative findings: JAMA

A recent study published in the Journal of American Medical Association investigated the efficacy of postoperative antibiotics in children with nonperforated appendicitis who exhibit gangrenous, suppurative or exudative (GSE) findings.

This retrospective cohort study was conducted across 16 hospitals that participated in a regional research consortium and analyzed data from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP)–Pediatric Appendectomy Targeted dataset. The research compared the surgical site infection (SSI) rates between children who received postoperative antibiotics with those who did not. 

This research included a total of 958 children with nonperforated appendicitis in the hospital-level analysis, with 573 (59.8%) receiving postoperative antibiotics. No correlation was found between the use of postoperative antibiotics and SSI rates when analyzed at hospital and patient levels.

The hospital-level analysis explored the association between postoperative antibiotic use and SSI rate ratios and found no significant correlation regardless of the overall rate of antibiotic use or the duration of antibiotic treatment.

Further analysis at the patient level included 404 patients who were propensity-matched who showed similar rates of SSI between those who received postoperative antibiotics and those who did not.

These findings suggest that the postoperative antibiotics use may not provide any added benefit in preventing SSIs in children with nonperforated appendicitis showing GSE findings. Furthermore, unnecessary antibiotic use contributes to antibiotic resistance and the risk of adverse reactions which highlights the importance of evidence-based approaches to prescribe antibiotics.

Reference:

Cramm, S. L., Graham, D. A., Blakely, M. L., Kunisaki, S. M., Chandler, N. M., Cowles, R. A., Feng, C., He, K., Russell, R. T., Allukian, M., Campbell, B. T., Commander, S. J., DeFazio, J. R., Dukleska, K., Echols, J. C., Esparaz, J. R., Gerall, C., Griggs, C. L., … Hanna, D. N. (2024). Postoperative Antibiotics, Outcomes, and Resource Use in Children With Gangrenous Appendicitis. In JAMA Surgery. American Medical Association (AMA). https://doi.org/10.1001/jamasurg.2023.7754