Implementation of an Evidence-Based Protocol after Appendectomy Reduces Unnecessary Antibiotics

Abstract Background Children with acute appendicitis have historically received intravenous antibiotics before and after appendectomy, yet recent literature supports minimizing post-operative antibiotics. In this study, we examined the impact of a standardized protocol that eliminates postoperative antibiotics for non-perforated appendicitis and discontinues antibiotics at discharge for perforated appendicitis. Methods A retrospective review of all pediatric patients who underwent laparoscopic appendectomy for acute appendicitis between May 2013 and March 2017 was performed. Preprotocol patients (5/1/2013–3/31/2015) were compared to post-protocol patients (5/1/2015-3/31/2017), excluding those who underwent surgery during the month of protocol introduction (4/2015). Primary outcomes were post-operative antibiotic doses for non-perforated cases and antibiotics after discharge for perforated cases. Mann-Whitney and Fisher’s exact tests were performed. Results Laparoscopic appendectomy was performed in 748 children before (PRE) and in 814 children after (POST) protocol implementation. Perforation rates were similar (POST 21.5 vs. PRE 21.8%, p = 0.90). For non-perforated appendicitis, post-operative antibiotics were reduced (median 0 [IQR 0-0] vs. 3 [0-5] doses, p  Conclusion For children with acute appendicitis, a standardized protocol can safely reduce unnecessary antibiotics and decrease length of stay. Furthermore, the judicious use of antibiotics does not increase SSI, readmission, or overall complication rates. Level of Evidence III