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More than one in three children with nonperforated appendicitis get postoperative antibiotics despite lack of evidence

OCTOBER 24, 2018
Clinical Congress Daily Highlights, Wednesday Second Edition

Although current guidelines recommend that children with nonperforated appendicitis receive preoperative broad-spectrum antibiotics, more than a third of these patients are given additional antibiotics postoperatively despite lack of supporting evidence, according to a new study led by Kibileri Williams, MD, MS, Howard University Hospital, Washington, DC.

In 2010, the American Pediatric Surgical Association (APSA), based on strong evidence, published a systematic review supporting the use of a single dose of preoperative antibiotics for nonperforated appendicitis, Dr. Williams said.

“There is no evidence to support additional postoperative antibiotic administration in these patients,” Dr. Williams said.

The study led by Dr. Williams aimed to investigate compliance with APSA recommendations for antibiotic administration for nonperforated appendicitis among children’s hospitals in the United States.

The researchers reviewed Pediatric Health Information System (PHIS) data from 2013 to 2016, including all children, 3 to 18 years old, who underwent a laparoscopic appendectomy for nonperforated appendicitis. Only those who had appendectomy on hospital day 0 or 1 were included. Those with length of stay greater than three days, an infection flag or with missing pharmacy data were excluded.

A total of 33,757 patients were identified from 47 children’s hospitals. They were mostly male (61 percent) and white (68 percent), with a median age at admission of 11 years old. About 12 percent were readmitted to the hospital due to surgical complications, she said.

“We found significant interhospital variation in antibiotic administration and compliance with evidence-based recommendations,” she said. “In only 64 percent of cases was the antibiotics administration appropriate.”

Antibiotics were administered after appendectomy in 35 percent of patients. There was significant variation among hospitals in the percentage of children who received postoperative antibiotics, which ranged from 6 percent to 92 percent.

Dr. Williams said the study did not look at whether compliance has increased or decreased since APSA issued its guidelines. In addition, it did not look for an association between postoperative antibiotics and patients with complications.

This variation across children’s hospitals highlights the need for standardization of care to mitigate the adverse effects of inappropriate antibiotic use in pediatric surgery, Dr. Williams said. She hopes the study will serve as a catalyst for better antibiotic stewardship in pediatric surgery.

View this study’s abstract online here.

Additional information

The Scientific Forum presentation, Postoperative Antibiotic Administration in Children with Non-Perforated Appendicitis, was held October 24 at the 2018 Clinical Congress of the American College of Surgeons in Boston.  Program, webcast and audio information is available online at

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