What is the recommended follow-up care after appendicitis?

Follow-Up Care After Appendicitis

For patients who have had appendicitis, follow-up care should include a 24-hour check to ensure resolution of symptoms in cases where imaging was negative or equivocal, and appropriate antibiotic management based on whether the appendicitis was complicated or uncomplicated. 1

General Follow-Up Recommendations

• For patients with imaging studies negative for suspected appendicitis but persistent symptoms, follow-up at 24 hours is recommended to ensure resolution of signs and symptoms due to the risk of false-negative results 1
• For patients with suspected appendicitis that could neither be confirmed nor excluded by diagnostic imaging, careful follow-up is recommended, with possible hospitalization if the index of suspicion remains high 1
• Local hospitals should establish clinical pathways to standardize diagnosis, in-hospital management, discharge, and outpatient management of appendicitis 1

Antibiotic Management in Follow-Up Care

Uncomplicated Appendicitis

• For patients with uncomplicated appendicitis who underwent appendectomy, postoperative antibiotics are not recommended 1
• In pediatric patients operated for uncomplicated appendicitis, postoperative antibiotic therapy should be avoided 1

Complicated Appendicitis

• For patients with complicated appendicitis, postoperative broad-spectrum antibiotics are recommended, especially if complete source control has not been achieved 1
• Antibiotics should not be prolonged longer than 3-5 days postoperatively in cases of complicated appendicitis with adequate source control 1
• In children with complicated appendicitis, early switch (after 48 hours) to oral administration of antibiotics is recommended, with an overall therapy duration shorter than 7 days 1
• Postoperative antibiotics can be administered orally if the patient is otherwise well enough to be discharged 1

Special Considerations for Different Patient Populations

Adults Over 40 Years

• Patients over 40 years old with complicated appendicitis treated non-operatively should undergo colonic screening with colonoscopy and interval full-dose contrast-enhanced CT scan due to the higher incidence (3-17%) of appendicular neoplasms in this age group 1

Children

• For children with complicated appendicitis, home oral antibiotic therapy has been shown to be as effective as intravenous therapy, with no difference in length of stay, postoperative abscess rate, or readmission rate 1
• Early transition to oral antibiotics in children with complicated appendicitis is safe, effective, and cost-efficient 1

Non-Operative Management Follow-Up

• The reported recurrence rate after non-surgical treatment for perforated appendicitis and phlegmon ranges from 12% to 24% 1
• Routine interval appendectomy after non-operative management for complicated appendicitis is not recommended for young adults (<40 years old) and children 1
• Interval appendectomy is recommended only for patients with recurrent symptoms 1

Common Pitfalls in Follow-Up Care

• Failing to follow up within 24 hours for patients with negative imaging but persistent symptoms can lead to missed diagnoses due to false-negative results 1, 2
• Prolonging antibiotic therapy beyond 3-5 days in complicated appendicitis with adequate source control provides no additional benefit and may contribute to antibiotic resistance 1
• Overlooking the need for colonic screening in patients over 40 years with complicated appendicitis treated non-operatively can miss potential neoplasms 1
• Unnecessary routine interval appendectomy after successful non-operative management adds surgical costs without clear benefit for most patients 1