B. P. Fenner1, F. Badru1, S. D. Larson1, R. Petroze1 1University Of Florida, Pediatric Surgery, Gainesville, FL, USA
Introduction:
Acute appendicitis is one of the most common reasons for hospital admission and surgical intervention in the pediatric population. The most common post-operative complication is intraabdominal abscess, which can require readmission and further procedures. Current guidance for the postoperative management of appendicitis discourages continuation of antibiotics post-operatively, except in the case of perforation.
Methods:
A single-center retrospective chart review was performed for patients less than 18 with an admitting diagnosis of acute appendicitis. Data abstracted includes patient demographics, initial laboratory values, operative details, antibiotic choice and duration, and microbiology and pathology results. Adverse outcomes including readmission, post-operative abscess, and C. difficile infection were noted.
Results:
Between May 1, 2020 and June 30, 2021, 219 patients presented with acute appendicitis. The mean age at enrollment was 12.33 ± 3.67. 133 (60.7%) patients were male and 86 (39.3%) were female. 23 (10.5%) patients were readmitted. Post-operative complications were noted in 15 patients (1 case of C. difficile infection, 14 intraabdominal abscesses). Of the 14 patients who developed an intraabdominal abscess, 11 required drainage. Culture of this fluid revealed pan-sensitive enteric pathogens in 10 patients and a negative culture in one patient. Figure 1 summarizes outcomes by pathology.
Conclusion:
Laparoscopic appendectomy is a commonly performed procedure in the pediatric population. Overall, the risk of complication is low, but post-operative abscesses remain relatively common. Interestingly, the rate of post-operative abscess in our cohort is higher in patients with a gangrenous appendicitis than grossly perforated appendicitis. Likely, many patients with gangrenous appendicitis have micro-perforations that are not diagnosed intraoperatively or on gross pathology. Patients with diagnosed perforated appendicitis are routinely given post-operative antibiotics and have a longer post-operative length of stay. Conversely, gangrenous appendicitis is generally treated as simple appendicitis without post-operative antibiotics. These patients have a decreased initial length of stay but a higher risk of readmission. Culture data reveals expected enteric pathogens that are pan-sensitive. Routine post-operative antibiotics in gangrenous appendicitis would likely reduce the abscess rate in these patients.
