What is the typical hospital stay duration for a patient with ruptured appendicitis (inflammation of the appendix) after undergoing an appendectomy (surgical removal of the appendix)?

From the Guidelines

The typical hospital stay for ruptured appendicitis after surgery is 5 days, as reported in a study published in the World Journal of Emergency Surgery in 2017 1. This duration can vary based on individual circumstances, such as the severity of the infection and the patient's overall health. Patients usually remain hospitalized until they can tolerate oral intake, have adequate pain control with oral medications, show no signs of infection, and have normal bowel function returning. The treatment regimen typically includes intravenous antibiotics, such as piperacillin-tazobactam or a combination of ceftriaxone and metronidazole, for several days, transitioning to oral antibiotics to complete a 7-10 day course. Pain management initially involves IV medications like morphine or hydromorphone, gradually transitioning to oral options like oxycodone or hydrocodone with acetaminophen. Recovery is longer for ruptured appendicitis compared to non-ruptured cases because the infection has spread beyond the appendix into the abdominal cavity, requiring more extensive treatment to clear the infection and prevent complications like abscess formation. Some key points to consider in the management of ruptured appendicitis include:

• The use of postoperative antibiotics, with a recommended duration of 3-5 days in patients with adequate source control 1
• The safety of early switch to oral antibiotics in children with complicated appendicitis, with an overall length of therapy shorter than 7 days 1
• The importance of individualized care, taking into account the patient's specific needs and circumstances. Patients should expect gradual resumption of activities, with full recovery taking 4-6 weeks, and should follow up with their surgeon 1-2 weeks after discharge. It is also worth noting that the optimal course of antibiotics remains to be identified, but current evidence suggests that longer postoperative courses do not prevent surgical site infections compared with 2 days of antibiotics 1. Overall, the management of ruptured appendicitis requires a comprehensive approach, taking into account the patient's individual needs and circumstances, as well as the latest evidence-based guidelines.

From the Research

Hospital Stay for Ruptured Appendicitis After Surgery

• The length of hospital stay for patients with ruptured appendicitis after surgery can vary depending on several factors, including the type of surgery, antibiotic treatment, and patient demographics 2, 3, 4, 5, 6.
• A study published in 2020 found that the duration of hospital stay for patients with acute complicated appendicitis was approximately 6.1 days, regardless of the duration of antibiotic treatment 2.
• Another study published in 2017 found that the use of metronidazole in combination with broad-spectrum antibiotics did not affect the length of hospital stay for patients with perforated appendicitis 3.
• A study published in 2007 found that conservative treatment with interval appendectomy for ruptured appendicitis with localized abscess or phlegmon resulted in a longer hospital stay compared to immediate appendectomy 4.
• A study published in 2020 identified several factors that can affect the length of hospital stay after laparoscopic appendectomy, including age, peritonitis, preoperative white blood cell count, and complicated appendicitis 5.
• A study published in 2016 found that the use of ceftriaxone and metronidazole once daily did not affect the length of hospital stay for children with perforated appendicitis 6.

Factors Affecting Hospital Stay

• Age: Older patients are more likely to have a longer hospital stay 5.
• Peritonitis: Patients with peritonitis are more likely to have a longer hospital stay 5.
• Preoperative white blood cell count: Patients with higher preoperative white blood cell counts are more likely to have a longer hospital stay 5.
• Complicated appendicitis: Patients with complicated appendicitis are more likely to have a longer hospital stay 5.
• Antibiotic treatment: The use of certain antibiotics, such as ertapenem, may be associated with a longer hospital stay 5.

Antibiotic Treatment

• The use of short-duration antibiotic treatment (3-5 days) has been shown to be effective in treating intra-abdominal contamination and may not affect the length of hospital stay 2.
• The use of metronidazole in combination with broad-spectrum antibiotics has been shown to be effective in treating perforated appendicitis, but may not affect the length of hospital stay 3.
• The use of ceftriaxone and metronidazole once daily has been shown to be effective in treating children with perforated appendicitis, but may not affect the length of hospital stay 6.