Abstract
BackgroundData on common practice in the management of patients with complex appendicitis are scarce, especially for the adult population. Variation in the definition of complex appendicitis, indications for and the type of prolonged antibiotic prophylaxis have not been well studied yet. The aim of this study was to document current practice of the classification and postoperative management of complex appendicitis on an international level.MethodsAn online survey was dispersed among practicing surgeons and surgical residents. Survey questions pertained to the definition of a complex appendicitis, indications for antibiotic prophylaxis after appendectomy, the duration, route of administration and antibiotic agents used.ResultsA total of 137 survey responses were eligible for analysis. Most respondents were from Northern or Western Europe and were specialized in gastrointestinal surgery. Opinion varied substantially regarding the management of appendicitis, in particular for phlegmonous appendicitis with localized pus, gangrenous appendicitis and iatrogenic rupture of appendicitis. The most common duration of postoperative antibiotics was evenly spread over <3, 3, 5 and 7 days. Whereas most respondents indicated a combined intravenous and oral route of administration was common practice, 28% answered a completely intravenous route of administration was standard practice.ConclusionCurrent practice patterns in the classification and postoperative management of complex appendicitis are highly variable.
Highlights
Acute appendicitis is a highly prevalent surgical emergency in both children and adults [1,2,3,4]
Survey questions pertained to the definition of a complex appendicitis, indications for antibiotic prophylaxis after appendectomy, the duration, route of administration and antibiotic agents used
There was a considerable variation in the definition of a complex appendicitis, indications for prolonged antibiotic prophylaxis after appendectomy and the antibiotic regimens used
Summary
Acute appendicitis is a highly prevalent surgical emergency in both children and adults [1,2,3,4]. Five days of antibiotics, switched from an intravenous to oral route as early as 48 h after surgery, is common use in many centers in the Netherlands [15, 16]. In pursuit of the optimum antibiotic regimen for complex appendicitis, a variety of treatment protocols have been reported [16, 21, 30,31,32,33]. Data on common practice in the management of patients with complex appendicitis are scarce, especially for the adult population. Variation in the definition of complex appendicitis, indications for and the type of prolonged antibiotic prophylaxis have not been well studied yet. The aim of this study was to document current practice of the classification and postoperative management of complex appendicitis on an international level
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