A. Gordon1, J. Choi1, H. Ginsburg1, K. Kuenzler1, J. Fisher1, S. Tomita1 1NYU Langone Health,Department Of Surgery, Division Of Pediatric Surgery,New York, NY, USA
Introduction: The management of uncomplicated appendicitis is well established, but there is little consensus regarding the optimal use of post-operative antibiotics for pediatric patients with perforated appendicitis. Patients are commonly discharged from the hospital with oral antibiotics after a course of IV antibiotics; however, recent literature suggests that patients can be safely discharged without any oral antibiotics. To further evaluate the safety of this protocol, we conducted a prospective multicenter observational study comparing rates of post-operative abscess formation and rehospitalization between patients discharged with and without oral antibiotics.
Methods: We reviewed the records of all pediatric patients who underwent appendectomies for perforated appendicitis at NYU Tisch Hospital, Bellevue Hospital, and Hackensack University Medical Center from January 2014 to June 2019. Patients who underwent interval appendectomies or were discharged on intravenous antibiotics (via a PICC line) were excluded. Data pertaining to patient demographics, hospital course, intra-operative appearance of the appendix, antibiotic treatment, abscess formation, and rehospitalization were collected. Numerical and categorical data were analyzed with Mann-Whitney U Tests and Fisher’s Exact Tests respectively.
Results: We identified 253 eligible patients, including 162 who received oral antibiotics and 91 sent home without any antibiotics. There were no significant differences in patient demographics, temperature at admission, white blood cell count at admission, duration of symptoms, intra-operative appearance of the appendix, and length of stay, The median length of antibiotic treatment (oral and IV) was 11 (10-14) days for patients on oral antibiotics and 5 (3-6) days for patients without oral antibiotics (p < 0.01). The median white blood cell count at discharge was 9.5 (7.4-10.9) and 8.1 (6.8-10.4) for these groups respectively (p = 0.02). Rates of post-operative abscess formation were 22% for patients receiving oral antibiotics and 15% for patients on no antibiotics (p = 0.25). Rates of rehospitalization for these groups were 10% and 11% respectively (p = 0.99).
Conclusion: Our results suggest that oral antibiotics do not decrease the rates of post-operative abscess formation or rehospitalization in pediatric patients with perforated appendicitis. Prospective, randomized controlled trials are needed to confirm these findings before discharging patients without oral antibiotics can become the standard of care.
