What does this research mean for the field?

Postoperative antibiotics do not reduce surgical site infection rates or improve outcomes in children with nonperforated appendicitis who have gangrenous, suppurative, or exudative findings. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 7, 2024JAMA SurgeryOpen Access

Postoperative Antibiotics, Outcomes, and Resource Use in Children With Gangrenous Appendicitis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Nonperforated appendicitis with gangrenous, suppurative, and exudative findings (n=958). Intervention: Postoperative antibiotics vs. No postoperative antibiotics. Primary outcome: Rate of 30-day postoperative surgical site infection (SSI) including both incisional and organ space infections (OR 0.75, 95% CI 0.16-3.39, p=.70).

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Key result

Postoperative antibiotics fail to reduce surgical site infections versus no antibiotics in pediatric nonperforated appendicitis.

OR 0.75
95% CI 0.16-3.39
P=.70
n=958

Why the study?

The role of postoperative antibiotics in preventing surgical site infections in children with nonperforated appendicitis with gangrenous, suppurative, or exudative findings was unclear.

Does continuation of antibiotics after appendectomy reduce 30-day postoperative SSI in children with nonperforated appendicitis with GSE findings?

Population

958 children with nonperforated appendicitis with GSE findings undergoing appendectomy

Comparison

Postoperative antibiotics continuation vs no postoperative antibiotics

Design

Retrospective cohort study using NSQIP-Pediatric Appendectomy Targeted data from 16 hospitals

Follow-up

30-day postoperative

Authors

SCShannon L. CrammBoston Children's Hospital DGDionne A. GrahamPediatric Cardiology MBMartin L. BlakelyThe University of Texas Health Science Center at Houston

Discussion

Member takes

Implication

Caution against routine postoperative antibiotics on observational data alone; leaves open efficacy in randomized trials for nonperforated appendicitis.

Study Design

Type

Cohort (n=958)

Multicenter

Yes

Structured PICO

Does continuation of antibiotics after appendectomy reduce 30-day postoperative SSI in children with nonperforated appendicitis with GSE findings?

Population

958 children (mean age 10.7 years, 40.8% female) with nonperforated appendicitis and gangrenous, suppurative, or exudative findings evaluated for 30-day postoperative surgical site infection.

Exposure

Continuation of antibiotics after appendectomy

Comparator

No postoperative antibiotics

Outcome

Rate of 30-day postoperative surgical site infection (SSI) including both incisional and organ space infectionshard clinical

Main Result

Odds Ratio: 0.75 (95% CI 0.16–3.39)

Absolute Event Rate: 1.5% vs 2%

p-value: p=.70

Postoperative antibiotics do not improve outcomes or reduce surgical site infections in children with nonperforated appendicitis with gangrenous, suppurative, or exudative findings.

Cite This Study

Cramm et al. (2024) conducted a cohort in Nonperforated appendicitis with gangrenous, suppurative, and exudative findings (n=958). Postoperative antibiotics vs. No postoperative antibiotics was evaluated on Rate of 30-day postoperative surgical site infection (SSI) including both incisional and organ space infections (OR 0.75, 95% CI 0.16-3.39, p=.70). Postoperative antibiotics did not reduce 30-day surgical site infections compared with no antibiotics in children with nonperforated appendicitis (1.5% vs 2.0%; OR 0.75; 95% CI 0.16-3.39; P=.70).

synapsesocial.com/papers/6aab6e2ac87f2e99954914f5 https://doi.org/10.1001/jamasurg.2023.7754

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Implication

Caution against routine postoperative antibiotics on observational data alone; leaves open efficacy in randomized trials for nonperforated appendicitis.

Postoperative Antibiotics, Outcomes, and Resource Use in Children With Gangrenous Appendicitis

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Postoperative Antibiotics, Outcomes, and Resource Use in Children With Gangrenous Appendicitis

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

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