Standardized Discharge Antibiotics May Reduce Readmissions in Pediatric Perforated Appendicitis

The Utility of Discharge Antibiotics in Pediatric Perforated Appendicitis Without Leukocytosis

“…A study of the American College of Surgeons NSQIP-Pediatric Appendectomy Pilot (NSQIP-P) database found that 57% of pediatric patients with perforated appendicitis were prescribed oral antibiotics on discharge, finding lower odds of organ-space SSI compared to children not receiving oral antibiotics on discharge. 8,9 Additionally, a single-center retrospective study investigated the effect of standardizing seven additional days of oral antibiotics on discharge, regardless of inpatient duration, and found decreased rates of organ-space SSI and readmissions. 9 However, other groups have studied the effects of shifting in the opposite direction, toward fewer antibiotic doses.…”

“…8,9 Additionally, a single-center retrospective study investigated the effect of standardizing seven additional days of oral antibiotics on discharge, regardless of inpatient duration, and found decreased rates of organ-space SSI and readmissions. 9 However, other groups have studied the effects of shifting in the opposite direction, toward fewer antibiotic doses. Some have found that discharge prior to postoperative day five without antibiotics in patients without leukocytosis was not associated with higher rates of SSIs.…”

“…Our rates of SSIs are similar to those in the literature which range from 1.6% to 20.7%. 6,9,13,16,18 Lastly, CPG adherence was variable. While reasons for this were not captured in the data in the electronic medical record, variable CPG adherence was at least partially due to the multi surgeon practice in an academic setting, which necessitates constant reeducation for rotating trainees and providers.…”

“…8 However, recent studies have evaluated prescribing a standardized additional 7 d of antibiotics on discharge to all pediatric patients with perforated appendicitis, resulting in a median total antibiotic duration of 11 d compared to 4 d prior to this change, and found that prescribing seven additional days of antibiotics on discharge was associated with fewer postoperative infections and readmissions. 9 It is clear from the literature that postoperative antibiotic treatment of pediatric patients with perforated appendicitis often differs from institution to institution with no clear guidelines. 10 With growing concerns of antibiotic resistance and conflicting benefits of longer-term antibiotic use, more evidence is needed to support the reduction of home antibiotic use in appropriate patients with perforated appendicitis.…”

Apandisitli çocukların yönetiminde standart belirlemenin sonuçları

“…This decrease in the number of readmissions to the hospital seems to be associated with postoperative complications. Ferguson et al found that oral administration of antibiotics for 7 days after discharge reduced the likelihood of re-admission (22) . (Ferguson Standardized The most important limitation of our study is that it is retrospective.…”