Archives of Disease in Childhood | 2019
OC18\u2005A novel standardised protocol for post-operative antibiotic use in appendicits. rbhsc study results at six months
Abstract
Background Variation persists nationwide in the post-operative management of complicated appendicitis. Following a review of recent publications, it seems that the most beneficial change to patient outcome is the use of a standardised departmental approach. This has been shown to be effective in multiple centres using clinical findings and white cell count (WCC). A local review however suggested that in our patient population, post-operative complications were more strongly correlated with elevated C-reactive protein (CRP). We implemented a novel protocol using CRP with clinical findings to standardise our post-operative antibiotic use and here present our findings after six months Methods A prospective data collection was completed to assess: Complicated appendicitis rate (operator observed perforated or gangrenous appendix) Post-operative length of stay Infective complication rate (Abscess or wound infection of Clavien Dindo Grade 2+) This was compared to all patients undergoing an appendicectomy over the previous six months. Results 42 patients completed the new protocol over six months (New), with 53 in the six months prior (Prior). New vs Prior; Age range was similar: 9 (6–12 IQR) vs 9 (7–11) and normal appendicectomy rate improved 4.7% (2/42) vs 11.3% (6/53). Complicated appendicitis rate was 50% (21/42) vs 42% (22/53). Mean post-operative length of stay for the complicated group did not change, 5.6 vs 5.9 days (p=0.38), and improved in the simple group, 2.1 v 3.1 days (p=0.01). Infective complication rate improved on the new protocol 9% (2/22) vs 27% (6/22). Conclusions After six months with the New protocol the post-operative length of stay did not increase for patients with complicated appendicitis and improved for those with simple appendicitis. Significantly the rate of post-operative infective complications has fallen. Our group hypothesise that the use of a standardised approach provides parents and staff with a clear post-operative plan and expedites discharge for patients with simple appendicitis. It also rationalises blood sampling and the antibiotic regimen appears to reduce infective complications. We plan to continue using the protocol and will review our results at one year.