Annals of surgery · 2025
Postoperative Antibiotics after Appendectomy for Acute Appendicitis: No Evidence of Benefit, Even With Intra-abdominal Fluid.
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Laroche Sophie, Voron Thibault, Raimbert Penelope, Collard Maxime K, Debove Clotilde, Paye François, Lefèvre Jérémie H, Parc Yann
Аннотация
OBJECTIVE: To evaluate the necessity of postoperative antibiotics following appendectomy for acute appendicitis (AA), particularly in patients with intra-abdominal fluid, and to identify factors associated with postoperative infections.
BACKGROUND: Postoperative antibiotic use after appendectomy remains controversial, especially in the presence of intra-abdominal fluid. While some surgeons prescribe antibiotics empirically, there is no consensus on whether they reduce the risk of postoperative infections in patients with intra-abdominal fluid accumulation.
METHODS: A retrospective study was conducted at Saint Antoine Hospital (2013-2020) analyzing 1539 patients with AA (abscess and peritonitis were excluded). The presence of intra-abdominal fluid, antibiotic use, and postoperative outcomes were recorded. Risk factors for infections were identified through univariate and multivariate analysis.
RESULTS: Intra-abdominal fluid was present in 880 patients (57.2%), with 474 exhibiting serosanguinous intra-abdominal fluid and 406 presenting purulent intra-abdominal fluid. Postoperative antibiotics were administered to 18.1% of patients, yet no significant difference in infection rates was found between patients with and without peritoneal intra-abdominal fluid. The study identified 3 independent risk factors for postoperative infection: American Society of Anesthesiologists score [hazard ratio (HR) = 5.129, P = 0.004], symptom duration >2 days (HR = 2.290, P = 0.029), and the presence of appendicolith (HR = 2.204, P = 0.042). Postoperative antibiotic use did not significantly prevent infections, but inadequate antibiotic therapy was associated with higher rates of readmission and infectious outcomes.
CONCLUSIONS: Routine use of postoperative antibiotics for AA, even with intra-abdominal fluid, may not be necessary. Further research is needed to determine whether a targeted antibiotic approach based on risk factors for postoperative infections can improve outcomes without exacerbating antibiotic resistance.
BACKGROUND: Postoperative antibiotic use after appendectomy remains controversial, especially in the presence of intra-abdominal fluid. While some surgeons prescribe antibiotics empirically, there is no consensus on whether they reduce the risk of postoperative infections in patients with intra-abdominal fluid accumulation.
METHODS: A retrospective study was conducted at Saint Antoine Hospital (2013-2020) analyzing 1539 patients with AA (abscess and peritonitis were excluded). The presence of intra-abdominal fluid, antibiotic use, and postoperative outcomes were recorded. Risk factors for infections were identified through univariate and multivariate analysis.
RESULTS: Intra-abdominal fluid was present in 880 patients (57.2%), with 474 exhibiting serosanguinous intra-abdominal fluid and 406 presenting purulent intra-abdominal fluid. Postoperative antibiotics were administered to 18.1% of patients, yet no significant difference in infection rates was found between patients with and without peritoneal intra-abdominal fluid. The study identified 3 independent risk factors for postoperative infection: American Society of Anesthesiologists score [hazard ratio (HR) = 5.129, P = 0.004], symptom duration >2 days (HR = 2.290, P = 0.029), and the presence of appendicolith (HR = 2.204, P = 0.042). Postoperative antibiotic use did not significantly prevent infections, but inadequate antibiotic therapy was associated with higher rates of readmission and infectious outcomes.
CONCLUSIONS: Routine use of postoperative antibiotics for AA, even with intra-abdominal fluid, may not be necessary. Further research is needed to determine whether a targeted antibiotic approach based on risk factors for postoperative infections can improve outcomes without exacerbating antibiotic resistance.