Postoperative Antibiotics And Time To Reach Discharge Criteria After Appendectomy For Complex Appendicitis
Abstract Background: Postoperative antibiotic treatment is indicated for 3 – 5 days following appendectomy for complex appendicitis. However, meeting discharge criteria may allow for safe discontinuation of antibiotics and discharge. This study assessed the association between time to reach discharge criteria and duration of postoperative antibiotic use and length of hospital stay. Methods: This was a multicenter retrospective cohort study including patients who underwent appendectomy for complex appendicitis and received postoperative antibiotics for >24 hours. Main outcome measures were time to reach discharge criteria, duration of postoperative antibiotic use, length of hospital stay and postoperative infectious complications. Discharge criteria were defined as absence of fever (temperature ≤38°C) for 24 hours, ability to tolerate oral intake and pain controlled by oral analgesics.Results: A total of 124 patients were included between May 2014 and January 2015. Median time to reach discharge criteria was 2 days (interquartile range 1 – 3). Postoperative antibiotics duration and hospital stay were 5 (IQR 3 – 5) and 5 (IQR 4 – 6) days, respectively. Infectious complications occurred in 15 of 124 patients (12%) and was not different between patients reaching discharge criteria before or after 2 postoperative days.Conclusions: Discharge criteria were met by a median of 2 days after appendectomy for complex appendicitis. This suggests that postoperative antibiotics and hospital stay can be reduced without an increase in infectious complications. In daily practice this is not done, prescribed antibiotics are not reduced in total days given. Prospective studies that evaluate limited postoperative antibiotic use, based on these criteria, are necessary.