83.14 Efficacy of Oral Antibiotics in Children with Post-Operative Abscess from Perforated Appendicitis

Posted on January 26, 2017

K. L. Weaver1, A. S. Poola1, K. W. Gonzalez1, S. D. St. Peter1  1Children’s Mercy Hospital,Department Of Pediatric General Surgery,Kansas City, MISSOURI, USA

Introduction:
Post-operative intra-abdominal abscess (PIAA) is the most common complication after appendectomy for perforated appendicitis (PA). This results in a protracted  medical course. Intravenous antibiotics by a peripherally inserted venous catheter are commonly employed to treat the abscess. We sought to evaluate the role of oral antibiotics in this population. 

Methods:
A retrospective review was conducted of children between January, 2005 to September, 2015 with a PIAA. Demographics, laboratory values, type and duration of antibiotics, interventions, imaging, length of stay, complications and hospital costs were all analyzed using descriptive statistics. Comparative analysis was performed on those who were treated with oral versus IV antibiotics after diagnosis of PIAA upon discharge utilizing a Pearson chi-square and Fisher’s exact test.  

Results:

103 children, of whom 66% where male with an average age at time of surgery of 11 + 3.6 years were included. Days of symptoms prior to admission was 3.2 + 2.3 days with a WBC of 17.9 + 6.4.  The median time to diagnosis of PIAA from appendectomy was 7 days (range 7-10) with 46% being treated with antibiotics only, 39% requiring drain placement and 15% aspiration. Mean total length of stay was 10 + 3.4 days. Comparing those who were discharged with oral antibiotics (42%) versus IV antibiotic therapy (58%), there was no significant difference in number of days of IV antibiotics prior to PIAA diagnosis, length of drain days if required, or total number of hospitalizations. However, there was a significant difference found in total length of hospital stay (9.1 vs. 10.7, p=0.02) and number of medical encounters required for treatment (3.4 vs. 4.4, p= <0.01). 

Conclusion:
PIAA treatment after appendectomy for PA can be treated with oral antibiotics with equivocal outcomes as IV antibiotic treatment, but with shorter length of hospitalizations and less medical encounters required.