Impact of postoperative antibiotics on outcomes for nonperforated appendicitis: A propensity score-matched retrospective cohort study.

Abstract

The use of postoperative antibiotics in patients with nonperforated appendicitis remains controversial, with limited evidence supporting routine administration. However, certain intraoperative findings, such as gangrenous, suppurative, or exudative, may increase the risk of infectious complications. This study evaluated the impact of postoperative antibiotics on infectious complications after laparoscopic appendectomy for nonperforated appendicitis with gangrenous, suppurative, or exudative findings. We retrospectively reviewed the records of patients who underwent laparoscopic appendectomies between July 2020 and December 2022. Patients younger than 18 years, those with perforated appendicitis, and those without gangrenous, suppurative, or exudative findings were excluded. All patients received preoperative antibiotics and were divided into 2 groups on the basis of postoperative antibiotic use. Propensity score matching was performed to adjust for differences in baseline characteristics. The correlation between postoperative antibiotic use and infectious complications for each surgeon was analyzed. A total of 367 adult patients with gangrenous, suppurative, or exudative findings were analyzed. After 1:1 propensity score matching, there were 119 patients in each group, with no differences in characteristics or outcomes between the 2 groups. Gangrene was identified as an independent variable affecting infectious complications (P = .020). Postoperative antibiotic use did not significantly reduce the incidence of infectious complications (11.8% vs 12.6%; P = .843). Although the surgeon-specific rate of postoperative antibiotic use varied, it did not correlate with the incidence of infectious complications (Spearman ρ -0.100; P = .873). Postoperative antibiotic use did not prevent infectious complications in nonperforated appendicitis with gangrenous, suppurative, or exudative findings but may be helpful in cases of gangrene.