Post-Appendectomy Discharge Care Recommendations
For patients who have undergone appendectomy, postoperative antibiotic management should be based on whether the appendicitis was complicated or uncomplicated, with no antibiotics needed for uncomplicated cases and a short course (3-5 days) for complicated cases with adequate source control.
Antibiotic Management
Uncomplicated Appendicitis
- Postoperative antibiotics are not recommended for adult patients with uncomplicated appendicitis as they provide no benefit in reducing surgical site infections 1
- Similarly, in pediatric patients with uncomplicated appendicitis, postoperative antibiotics have no role in reducing surgical site infection rates 1
- A single preoperative dose of broad-spectrum antibiotics is sufficient for infection prevention in uncomplicated cases 2
Complicated Appendicitis
- Postoperative broad-spectrum antibiotics are recommended for adult patients with complicated appendicitis (perforated, abscess, or peritonitis), especially if complete source control has not been achieved 1
- The optimal duration of antibiotics for complicated appendicitis is 3-5 days, with evidence showing no benefit to longer courses 1, 3
- For adult patients with adequate source control, discontinuation of antibiotics after 24 hours appears safe and is associated with shorter hospital stays and lower costs 1, 2
- In elderly patients with complicated appendicitis, a period of 3-5 days of antibiotics is suggested, with discontinuation based on clinical and laboratory criteria such as fever and leukocytosis 1
Pediatric-Specific Recommendations
- For children with complicated appendicitis, early switch (after 48 hours) to oral antibiotics is recommended 1
- Total antibiotic therapy duration should be less than 7 days in pediatric patients with complicated appendicitis 1, 4
- Children with perforated appendicitis may be safely discharged home on oral antibiotics when enteral intake is tolerated, regardless of fever or leukocytosis 4
- Recent evidence suggests that children meeting discharge criteria with normal leukocyte count can be safely discharged without oral antibiotics after laparoscopic appendectomy for perforated appendicitis 5
Antibiotic Selection
- For complicated appendicitis, broad-spectrum antibiotics effective against enteric gram-negative organisms and anaerobes should be used 1
- Options include piperacillin-tazobactam, ampicillin-sulbactam, ticarcillin-clavulanate, or carbapenems 1, 2
- For perforated appendicitis, common combinations include ampicillin, clindamycin (or metronidazole), and gentamicin 1
- Metronidazole is not indicated when broad-spectrum antibiotics such as aminopenicillins with β-lactam inhibitors or carbapenems are used 1
Follow-up Recommendations
- Patients ≥40 years with complicated appendicitis treated non-operatively should undergo both colonic screening with colonoscopy and interval full-dose contrast-enhanced CT scan due to higher incidence of appendicular neoplasms 1, 2
- Routine interval appendectomy after non-operative management for complicated appendicitis is not recommended for young adults and children 2
- Interval appendectomy should be performed only for patients with recurrent symptoms 2
Outpatient Management
- Selected patients with uncomplicated appendicitis who have undergone laparoscopic appendectomy can be safely discharged on the same day of surgery 6
- Patients should be monitored for signs of complications including surgical site infections, which are associated with diabetes, free fluid, abscess, or perforation on preoperative imaging 1
- Early mobilization and adequate nutritional support should be encouraged to promote wound healing 7
Wound Care
- Wound ring protectors during the initial surgery have shown evidence of surgical site infection reduction in open appendectomy 7
- The World Society of Emergency Surgery strongly recommends against the routine use of drains following appendectomy for complicated appendicitis in adults 7
- Immediate evaluation is required for crepitus near the postoperative site as it may indicate subcutaneous emphysema, potentially signaling wound infection or anastomotic leak 7