Antibiotic stewardship in non-perforated gangrenous appendicitis: outcomes of single-dose versus postoperative therapy in a retrospective cohort study.

PURPOSE: Nonperforated gangrenous appendicitis (NGA) is a severe inflammatory condition without perforation, and the optimal duration of postoperative antibiotic therapy remains debated. This study aimed to compare outcomes between single-dose antibiotic therapy (SDAT) and postoperative antibiotic therapy (POAT).

METHODS

This retrospective study compared outcomes among 242 adult patients diagnosed histopathologically with NGA after laparoscopic appendectomy who received SDAT versus POAT antibiotics. Demographic characteristics, clinical scores, inflammatory biomarkers, antibiotic regimens, and postoperative surgical infectious complications (PSCs) within 30 days were evaluated. To address group non-homogeneity, regression analyses were performed, and propensity score matching (PSM) was applied as a sensitivity analysis.

RESULTS

Among the cohort, 68.2% received SDAT and 31.8% received POAT. In the unadjusted analysis, SDAT was associated with significantly shorter hospital stays (14 vs. 79 h; p < 0.001), and PSC rates were lower in the SDAT group (3.6% vs. 11.7%; p = 0.022). However, POAT patients had higher baseline severity markers, older age, elevated CRP, and higher ASA and q-SOFA scores. After propensity score matching on these variables, PSC rates were comparable between groups (11.3% vs. 9.7%; OR 0.84, 95% CI 0.27-2.66; p = 0.769), with no significant differences in intra-abdominal abscess or surgical site infection rates.

CONCLUSIONS

These findings suggest that SDAT is a sufficient antibiotic strategy for non-perforated gangrenous appendicitis and supports its use as routine practice in line with antibiotic stewardship principles. However, given the retrospective design, causal inference is limited, and prospective multicentre studies are warranted to confirm these findings.