Complicated Appendicitis: Are Extended Antibiotics Necessary? A Post Hoc Analysis of the EAST Appendicitis "MUSTANG" Study. J Surg Res 2020 Mar;247:508-513
Date
12/10/2019Pubmed ID
31812337DOI
10.1016/j.jss.2019.09.054Scopus ID
2-s2.0-85076628550 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: The need for extended postoperative antibiotics (Abx) for complicated (gangrenous or perforated) appendicitis (CA) remains unclear. We hypothesize that giving ≤24 h of Abx for CA is not inferior to a longer duration in preventing infectious complications after appendectomy.
METHODS: In this post hoc analysis of a prospective multicenter study, only patients with intraoperative diagnosis of CA were included. ANOVA and Chi-squared tests were used to compare length of stay, 30-day readmission rates, surgical site infection (SSI), and intra-abdominal abscess (IAA) between patients receiving ≥96 h and ≤24 h of Abx.
RESULTS: Of 751 patients with CA, 704 met inclusion criteria. Mean age was 48 (±17) y; 391 (56%) were male. A total of 185 (26%) received Abx for ≤24 h and 100 (14% of overall) received no Abx. 85 (12%) patients were lost to follow-up at 30 d postop. Twenty-seven (4%) patients developed an SSI (≤24 h = 5 (3%), ≥96 h = 22 (5%), P = 0.502) and 82 (13%) developed IAA (≤24 h = 11 (7%), ≥96 h = 71 (15%), P = 0.008) within 30d postop. Sixty-six (11%) patients underwent a secondary intervention for infection within 30 d postop. 41% of SSIs (11/27) and 60% (49/82) of IAA occurred during the index hospitalization. On the multivariate analysis, there was not any evidence of an association between the duration of Abx and an increased rate of SSI (P = 0.539), IAA (P = 0.274), emergency department visits (P = 0.509), readmission (P = 0.911), or secondary interventions (P = 0.523).
CONCLUSIONS: No evidence of an association between the duration of Abx (≤24 h versus ≥ 96 h) for complicated appendicitis and an increased rate of SSI was observed and ≤24 h duration was associated with shorter length of stay. Because of possible selection bias, adequately powered randomized trials are required to definitely prove noninferiority of shorter course Abx duration.
Author List
Bou Zein Eddine S, Dodgion CM, Qian S, Trevino C, De Moya MA, Yeh DD, EAST Appendicitis Research GroupAuthors
Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of WisconsinChristopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin
Colleen Trevino PhD APP Clinical Dir Inpatient 2 in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Abdominal AbscessAdult
Aged
Anti-Bacterial Agents
Antibiotic Prophylaxis
Appendectomy
Appendicitis
Drug Administration Schedule
Emergency Service, Hospital
Female
Follow-Up Studies
Humans
Length of Stay
Male
Middle Aged
Patient Readmission
Postoperative Care
Prospective Studies
Reoperation
Surgical Wound Infection
Time Factors
Treatment Outcome
