• Elisabeth M L de Wijkerslooth, Anne Loes van den Boom, and Wijnhoven Bas P L BPL Department of Surgery, Suite Na-2117, Erasmus MC - University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands..
• Department of Surgery, Suite Na-2117, Erasmus MC - University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. e.dewijkerslooth@erasmusmc.nl.
• World J Surg. 2019 Feb 1; 43 (2): 439-446.

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.

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