SP2.03 A Retrospective Review of Antibiotic Usage in Appendicectomy at a District General Hospital

Abstract

Introduction Post-operative infection is a recognised complication of appendicectomy with antibiotics frequently administered to mitigate this risk. However, optimal antibiotic use peri-operatively remains debated. This retrospective study analysed antibiotic usage in appendicectomy patients, categorised according to the Centres for Disease Control and Prevention surgical wound classification system (SWC). Methods Data was collected from October 2023 to September 2024 at a district general hospital. All patients undergoing emergency laparoscopic or open appendicectomies were included. Anova and t-tests were used for analysis. Results A total of 263 patients, aged 5 to 87 years, were included, comprising 52% females (138) and 48% males (125).Of these, 156 (59%) had SWC 2, 31 (11%) had SWC 3, and 76 (30%) had SWC 4.Pre-operative antibiotics were administered to 227 patients(83%), with ceftriaxone and metronidazole being the most prescribed (206, 91%). Post-operative antibiotics were given to 29 patients (11%), with 79% receiving oral co-amoxiclav. The mean length of antibiotics prescribed varied significantly (p <0.05) by SWC: 3 days for SWC 2, 5 days for SWC 3, and 9 days for SWC 4. There was also increased variance in antibiotic duration for SWC 4. Most patients (204, 77.6%) had a length of stay (LOS) of less than 5 days, and longer LOS was associated with prolonged antibiotic use. Conclusions This study highlights variability in antibiotic use, especially in SWC 4 patients, with many SWC 2 and 3 patients unnecessarily receiving antibiotics. Standardised protocols are crucial for optimising infection prevention, reducing antibiotic resistance, and improving surgical outcomes.