C. Dekonenko1, L. A. Benedict1, J. Sujka1, J. Sobrino1, R. M. Dorman1, D. Ostlie2, P. Aguayo1, S. D. St. Peter1, T. A. Oyetunji1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Surgery,Kansas City, MO, USA 2Phoenix Children’s Hospital,Surgery,Phoenix, AZ, USA
Introduction: We previously developed an institutional protocol to address antibiotic overutilization in children with perforated appendicitis. At the time of hospital discharge, children with a normal leukocyte count for age are sent home without oral antibiotics. Whether a normal leukocyte count sufficiently discriminates the risk of abscess remains unknown. The purpose of our study is to assess the effectiveness of this protocol by determining which children may still benefit from additional oral antibiotics at discharge even in the setting of a normal leukocyte count for age.
Methods: A retrospective review of prospectively collected data was conducted. Children undergoing a laparoscopic appendectomy at our freestanding children’s hospital between August 2011-December 2013 and December 2015-July 2017 were included. Patients with perforated appendicitis and discharged home without oral antibiotics were classified according to whether they re-presented with a post-operative abscess or not. Demographic data, post-operative length of stay and discharge leukocyte counts were abstracted from patient medical records. Comparative analysis was performed in STATA with a p value <.05 determined as significant.
Results: A total of 361 children were included, with 7% (n=25) re-presenting with a post-operative abscess following discharge. Among those who developed a post-operative abscess, the median leukocyte count at discharge was 10.5 (IQR: 8.7, 12.5) compared to 8.7 for the children who did not develop a post-operative abscess (IQR: 7.2, 10.4, p=.005). Furthermore, children with a post-operative abscess were older (11.8, IQR: 10.9, 14) compared to children who did not develop an abscess (9.1, IQR: 6.4, 12.5, p=.006). The receiver operator characteristic (ROC) curve for a leukocyte count greater than 10 had an area of .63.
Conclusion: Children with a leukocyte count greater than 10 at discharge, as opposed to normal for age, may benefit from oral antibiotics at discharge following laparoscopic appendectomy for perforated appendicitis.