Sturdivant Matthew, Downs Patrick, Lara-Gutierrez Jorge, Maalouf Majed, Esper Christopher, Gilleland William, Henwood Jon, Myers Christopher, Giuseppucci Pablo
General Surgery, University of Pittsburgh Medical Center (UPMC) Horizon, Hermitage, USA.
Cureus. 2023 Jun 18;15(6):e40603. doi: 10.7759/cureus.40603. eCollection 2023 Jun.
Appendicitis is a very common diagnosis that surgeons manage daily. Some surgeons are still giving antibiotics to patients suffering from uncomplicated appendicitis in the postoperative setting, despite an abundance of evidence to support a single preoperative dose of antibiotics. In this paper, we will describe the management of post-operative antibiotics at our institutions following uncomplicated appendicitis with regard to the use of antibiotics in the post-operative setting.
A retrospective chart review was performed analyzing post-operative antibiotic use and postoperative complications in 179 patients undergoing laparoscopic appendectomy for uncomplicated appendicitis. We retrospectively examined the patients to change our future practices as we perform appendectomies routinely, and there is practice variation at our centers. Current Procedural Terminology (CPT) codes for 'laparoscopic appendectomy' were used to identify the patients within our inclusion criteria. Twenty-four patients were excluded from the analysis as they had complicated appendicitis or met other exclusion criteria. We only studied the patient with uncomplicated appendicitis, as those with complicated appendicitis have a different clinical course that involves post-operative antibiotic administration or prolonged antibiotic administration with or without drain placement. Both arms of the study were homogeneous regarding patient characteristics. An independent test of the development of wound infection for those patients receiving post-operative antibiotics versus those not receiving post-operative antibiotics was conducted using the SPC XL 2010 Microsoft Excel (Redmond, USA) add-in. A p-value of <0.05 was considered statistically significant. This included the odds ratio for the development of complications. Results: There was no difference in the risk of infection rate in patients given post-operative antibiotics; however, given the odds ratio of 6.53, there is an association between an increased wound infection rate and patients who received post-operative antibiotics. Discussion: An appendectomy is a standard surgical procedure for acute appendicitis. The guidelines for using pre-operative antibiotics in uncomplicated appendicitis are well established; however, there is no specific recommendation on whether to continue antibiotics post-operatively. However, there is significant provider variability on this topic. Antibiotic use post-operatively in clean-contaminated cases, such as uncomplicated acute appendicitis, has been associated with higher risks of surgical site infections. Conclusion: The use of antibiotics post-operatively may not be indicated for uncomplicated laparoscopic appendectomy and may increase wound infections. A large-scale study including a larger population and extending it to other hospitals may increase statistical significance and help guide physician management.
阑尾炎是外科医生日常处理的常见疾病诊断。尽管有大量证据支持术前单次使用抗生素，但仍有一些外科医生在术后给患单纯性阑尾炎的患者使用抗生素。在本文中，我们将描述在我们机构中，对于单纯性阑尾炎术后抗生素的使用管理情况。
进行回顾性病历审查，分析179例行腹腔镜阑尾切除术治疗单纯性阑尾炎患者的术后抗生素使用情况和术后并发症。我们对患者进行回顾性检查，以便在我们常规进行阑尾切除术时改变未来的做法，并且我们中心存在实践差异。使用“腹腔镜阑尾切除术”的当前程序编码（CPT）来识别符合纳入标准的患者。24例患者因患有复杂性阑尾炎或符合其他排除标准而被排除在分析之外。我们仅研究单纯性阑尾炎患者，因为复杂性阑尾炎患者有不同的临床病程，涉及术后使用抗生素或延长抗生素使用时间（无论是否放置引流管）。研究的两组患者在患者特征方面具有同质性。使用SPC XL 2010 Microsoft Excel（美国雷德蒙德）插件对接受术后抗生素治疗的患者与未接受术后抗生素治疗的患者进行伤口感染发生情况的独立测试。p值<0.05被认为具有统计学意义。这包括并发症发生的比值比。结果：接受术后抗生素治疗的患者感染率风险没有差异；然而，鉴于比值比为6.53，伤口感染率增加与接受术后抗生素治疗的患者之间存在关联。讨论：阑尾切除术是治疗急性阑尾炎的标准外科手术。在单纯性阑尾炎中使用术前抗生素的指南已经确立；然而，对于术后是否继续使用抗生素没有具体建议。然而，在这个问题上医生之间存在很大差异。在清洁-污染手术（如单纯性急性阑尾炎）中术后使用抗生素与手术部位感染的较高风险相关。结论：单纯性腹腔镜阑尾切除术后可能无需使用抗生素，且可能增加伤口感染。一项包括更多人群并扩展到其他医院的大规模研究可能会增加统计学意义，并有助于指导医生的管理。
