Morita Kaori, Fujiogi Michimasa, Michihata Nobuaki, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo, Fujishiro Jun
Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.
Department of Pediatric Surgery, National Center for Child Health and Development, Setagayaku, Tokyo, Japan.
Eur J Pediatr Surg. 2023 Feb;33(1):74-80. doi: 10.1055/a-1958-7915. Epub 2022 Oct 11.
There is little consensus regarding management after appendectomy for complicated appendicitis in children. Recent literature suggests that patients may be safely discharged without oral antibiotics after adequate intravenous antibiotics therapy. We conducted a nationwide retrospective cohort study comparing the proportion of postoperative organ space infection between patients discharged with and without oral antibiotics after appendectomy followed by intravenous antibiotics therapy for complicated appendicitis.
Using the Diagnosis Procedure Combination database, we identified patients between 3 and 18 years of age who had undergone appendectomy for complicated appendicitis between July 2010 and March 2018. Propensity score-matched analyses were performed to compare outcomes between the groups with and without oral antibiotics. The primary outcome was readmission due to organ space infection within 60 days of discharge and the secondary outcome was 60-day readmission due to any reason. Additionally, we conducted a stabilized inversed probability of treatment weighting analysis as a sensitivity analysis.
We identified 13,100 eligible patients who had received oral antibiotics ( = 3,501) and who had not received oral antibiotics (n = 9,599). Propensity score matching created 2,769 pairs. Readmissions due to organ space infection were 3.4% and 5.2% in the nonusers and users of oral antibiotics, respectively ( = 0.007). The oral antibiotics users also had a significantly higher proportion of readmission due to any reason than the nonusers (5.5 vs. 7.4%, = 0.004). The sensitivity analyses demonstrated consistent results.
Among children who had undergone appendectomy for complicated appendicitis, oral antibiotics following discharge after adequate intravenous antibiotics therapy may increase organ space infection.
对于儿童复杂性阑尾炎阑尾切除术后的管理，目前几乎没有共识。最近的文献表明，在接受足够的静脉抗生素治疗后，患者可以安全出院而无需口服抗生素。我们进行了一项全国性的回顾性队列研究，比较了复杂性阑尾炎阑尾切除术后接受静脉抗生素治疗的患者出院时使用和不使用口服抗生素的术后器官间隙感染比例。
利用诊断程序组合数据库，我们确定了2010年7月至2018年3月期间因复杂性阑尾炎接受阑尾切除术的3至18岁患者。进行倾向评分匹配分析以比较使用和不使用口服抗生素的组之间的结果。主要结局是出院后60天内因器官间隙感染再次入院，次要结局是因任何原因导致的60天再次入院。此外，我们进行了稳定的逆概率治疗加权分析作为敏感性分析。
我们确定了13100例符合条件的患者，其中接受口服抗生素的患者有3501例，未接受口服抗生素的患者有9599例。倾向评分匹配产生了2769对。未使用口服抗生素和使用口服抗生素的患者因器官间隙感染再次入院的比例分别为3.4%和5.2%（P = 0.007）。口服抗生素使用者因任何原因再次入院的比例也显著高于未使用者（5.5%对7.4%，P = 0.004）。敏感性分析显示了一致的结果。
在因复杂性阑尾炎接受阑尾切除术的儿童中，在接受足够的静脉抗生素治疗后出院时使用口服抗生素可能会增加器官间隙感染。
