Postoperative Antibiotics after Appendectomy for Acute Appendicitis: No Evidence of Benefit, Even With Intra-abdominal Fluid.

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.