SP 6.09 Should we Continue Antibiotics in Children After Performing Laparoscopic Appendicectomy? A QIP
Abigail Richards, Kaso Ari, Vamsi Velchuru, Christopher LiaoAbstract
Aims
Unnecessary postoperative antibiotic use in paediatric appendicitis contributes to antimicrobial resistance. GIRFT guidance recommends withholding postoperative antibiotics in children with simple appendicitis; however, adherence in routine practice is variable. This quality improvement project aim is 100% cessation rate of postoperative antibiotics following appendicectomy for simple acute appendicitis in children at a district general hospital.
Methods
A two-cycle retrospective quality improvement audit was conducted including all laparoscopic appendicectomies performed in children aged 5–16 years with appendicitis. Baseline compliance with postoperative antibiotic cessation was assessed in cycle 1. Targeted education and dissemination of GIRFT guidelines was done over a six-month period. Cycle 2 data were collected. Primary outcomes were compliance with antibiotic cessation, with secondary outcomes including 30-day postoperative complications.
Results
In cycle 1, 42 cases were reviewed, of which 52% were simple and 48% were complex acute appendicitis. Postoperative antibiotics were appropriately discontinued in 36% of simple appendicitis cases. One patient in the complex appendicitis group developed a postoperative infection within 30 days. In cycle 2, 36 cases were reviewed, including 22 cases of simple acute appendicitis. Antibiotics were discontinued postoperatively in 60% of eligible patients. No 30-day postoperative complications were observed. All patients with simple appendicitis managed without postoperative antibiotics had uncomplicated recoveries.
Conclusion
This project significantly improved compliance with postoperative antibiotic cessation in paediatric appendicectomy from 36% to 60% without compromising patient safety. Sustainability will be supported through ongoing team education and incorporation of GIRFT guidance into local protocols, with planned re-audit to achieve 100% compliance.