Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands,
Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
Dig Surg. 2020;37(2):101-110. doi: 10.1159/000497482. Epub 2019 Jun 4.
Postoperative antibiotics are recommended after appendectomy for complex appendicitis to reduce infectious complications. The duration of this treatment varies considerably between and even within institutions. The aim of this review was to critically appraise studies on duration of antibiotic treatment following appendectomy for complex appendicitis. A systematic literature search according to the PRISMA guidelines was performed. Comparative studies evaluating different durations of postoperative antibiotic therapy. Primary endpoint was intra-abdominal abscess (IAA) after appendectomy. Secondary endpoints were surgical site infection, readmission and length of hospital stay. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Pooled event rates were calculated using a random-effects model. Nine studies reporting 2006 patients with complex appendicitis were included. The methodological quality of the included articles was poor. IAA was seen in 138 patients (8,6%). Meta-analysis revealed a statistically significant difference in IAA incidence between antibiotic treatment of ≤5 vs. >5 days (risk ratio (OR) 0.36 [95% CI 0.23-0.57] (p < 0.0001)) but not between ≤3 vs. >3 days (OR 0.81 [95% CI 0.38-1.74] (p = 0.59)). Descriptive statistics were used for secondary endpoints. The duration of postoperative antibiotic treatment is not associated with IAA following appendectomy for complex appendicitis.
术后抗生素被推荐用于复杂性阑尾炎切除术后，以减少感染性并发症。这种治疗的持续时间在不同机构甚至在机构内部差异很大。本综述的目的是批判性地评价关于复杂性阑尾炎切除术后抗生素治疗持续时间的研究。根据 PRISMA 指南进行了系统的文献检索。比较研究评估了不同术后抗生素治疗持续时间。主要终点是阑尾切除术后的腹腔内脓肿 (IAA)。次要终点是手术部位感染、再入院和住院时间。证据质量使用推荐评估、制定和评估 (GRADE) 工具进行评估。使用随机效应模型计算汇总事件发生率。纳入了 9 项研究，共 2006 例复杂性阑尾炎患者。纳入文章的方法学质量较差。138 例患者（8.6%）出现 IAA。荟萃分析显示，抗生素治疗≤5 天与>5 天相比，IAA 发生率存在统计学显著差异（风险比（OR）0.36 [95%CI 0.23-0.57]（p<0.0001）），但≤3 天与>3 天相比则无差异（OR 0.81 [95%CI 0.38-1.74]（p=0.59））。次要终点使用描述性统计。复杂性阑尾炎切除术后抗生素治疗的持续时间与 IAA 无关。
