Preoperative Antibiotic Administration Improves Patient Safety
The intervention that most improves surgical and patient safety in this case is administering preoperative IV antibiotics 0-60 minutes before surgical incision (Option A is partially correct for equipment preparation, but Option B's omission of antibiotics is dangerous and should be rejected). 1
Why Preoperative Antibiotics Are Critical
A single IV dose of broad-spectrum antibiotics (e.g., cefazolin or piperacillin-tazobactam) given 0-60 minutes before skin incision significantly reduces wound infections and postoperative intra-abdominal abscesses in appendectomy patients. 1
The 2020 World Society of Emergency Surgery Jerusalem Guidelines issue a strong recommendation (Class 1, Level A—highest quality evidence) for preoperative antibiotic prophylaxis, based on meta-analyses of >9,500 patients demonstrating clear benefit. 1
The presence of fever >38°C in this patient reinforces the need for preoperative antibiotics but does not alter the timing or choice of regimen. 1
Cefazolin is FDA-approved for perioperative prophylaxis and may reduce the incidence of postoperative infections in contaminated or potentially contaminated surgical procedures. 2
Why Omitting Antibiotics Is Dangerous
Delaying or omitting preoperative antibiotics to "accelerate the process" directly contradicts evidence-based practice and increases the risk of surgical site infections and intra-abdominal abscesses. 1
The prophylactic dose must be given before incision; administering antibiotics intraoperatively does not provide the documented benefit. 1
Asthma Management Cannot Be Ignored
Ignoring the patient's asthma history breaches basic perioperative care standards; even well-controlled asthma warrants preoperative assessment to stratify anesthetic risk. 1
Laparoscopic appendectomy creates pneumoperitoneum, which alters respiratory mechanics—making documented asthma history clinically relevant for intraoperative ventilation planning. 1
Coordination with anesthesia is advised to optimize bronchodilator therapy and avoid histamine-releasing agents, reducing the risk of intraoperative bronchospasm. 1
Site Marking and Equipment Preparation
While routine equipment preparation is a baseline requirement, site marking does not independently improve outcomes in appendectomy because the anatomical location of the appendix is fixed and non-lateralized. 1
Site marking is primarily relevant for lateralized procedures; it adds no safety benefit for appendectomy. 1
Surgical Approach and Timing
Laparoscopic appendectomy is the treatment of choice, offering less pain, lower surgical site infection rates, shorter hospital stay, and better quality of life compared to open appendectomy. 3, 4, 1
Surgery should be performed within 24 hours of admission to minimize complications; delaying beyond this window increases adverse outcomes. 4, 1, 5
Postoperative Antibiotic Management
For uncomplicated appendicitis with adequate source control, no postoperative antibiotics are required beyond the single preoperative dose. 4, 1
If intraoperative findings reveal complicated appendicitis (perforation, abscess), postoperative antibiotics should be continued but limited to 3-5 days. 4, 1
Critical Pitfalls to Avoid
Never omit preoperative antibiotics to save time—this practice increases infection risk and contradicts all major guidelines. 1
Never ignore asthma history, even if well-controlled—pneumoperitoneum and anesthetic agents can precipitate bronchospasm. 1
Do not delay surgery beyond 24 hours from admission unless there is a specific contraindication. 4, 1, 5