• Seema P Anandalwar, Dionne A Graham, Mark A Kashtan, Jonathan L Hills-Dunlap, and Shawn J Rangel.
• Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
• Ann. Surg. 2021 Apr 1; 273 (4): 821825821-825.

ObjectiveTo compare postdischarge rates of organ space infections (OSI) in children with complicated appendicitis between those receiving and not receiving oral antibiotics (OA) following discharge.Summary Background DataExisting data regarding the clinical utility of extending antibiotic treatment following discharge in children with complicated appendicitis are limited.MethodsRetrospective cohort study of children ages 3 to 18 years undergoing appendectomy for complicated appendicitis from January 2013 to June 2015 across 17 hospitals participating in the NSQIP-Pediatric Appendectomy Pilot Collaborative (n = 711). Multivariable mixed-effects regression was used to compare postdischarge OSI rates between patients discharged with and without OA after propensity matching on demographic characteristics and disease severity. A subgroup analysis was performed for high-severity patients (multiple intraoperative findings of complicated disease or length of stay≥6 d).ResultsThe overall rates of OA utilization and OSI following discharge were 57.0% (hospital range: 3-100%) and 5.2% (range: 0-16.7%), respectively. In the propensity-matched analysis of the entire cohort, use of OA was associated with a 38% reduction in the odds of OSI following discharge compared with children not discharged on OA (4.2% vs. 6.6%, OR 0.62 [0.29, 1.31], P = 0.21). In the high-severity matched cohort (n = 324, 46%), use of OA was associated with a 61% reduction in the odds of OSI following discharge (4.3% vs 10.5%; OR 0.39 [0.15, 0.96], P = 0.04).ConclusionsUse of oral antibiotics following discharge may decrease organ space infections in children with complicated appendicitis, and those presenting with high-severity disease may be most likely to benefit.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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