TY - JOUR
T1 - Postoperative recovery in peroral versus intravenous antibiotic treatment following laparoscopic appendectomy for complicated appendicitis
T2 - a substudy of a cluster randomized cluster crossover non-inferiority study
AU - Mohamud, Ahmed Abdirahman
AU - Zeyghami, Walid
AU - Kleif, Jakob
AU - Gögenur, Ismail
N1 - © 2024. The Author(s).
PY - 2024/10/9
Y1 - 2024/10/9
N2 - BACKGROUND: Acute appendicitis is the most common cause of abdominal pain requiring surgery, usually managed with laparoscopic appendectomy. In Denmark, the standard postoperative treatment for complicated cases involves intravenous antibiotics. This study compares peroral versus intravenous antibiotics in the context of fast-track surgery and Enhanced Recovery After Surgery (ERAS) protocols. Our objective is to evaluate the impact of peroral versus intravenous antibiotics on patient-reported outcomes following laparoscopic appendectomy for complicated appendicitis.METHODS: This was a sub-study within a broader Danish cluster-randomized non-inferiority trial conducted at Zealand University Hospital, focusing on adult patients undergoing laparoscopic appendectomy for complicated appendicitis. Participants were randomized into two groups: one receiving a three-day course of peroral antibiotics and the other intravenous antibiotics after surgery. Recovery quality was assessed on the third postoperative day using the Quality of Recovery-15 (QoR-15) questionnaire.RESULTS: The study included 54 patients, 23 in the peroral and 31 in the intravenous groups. The peroral group reported significantly better recovery outcomes, with higher QoR-15 scores (mean difference of 12 points, p < 0.001). They also experienced shorter hospital stays, averaging 47 h less than the intravenous group (p < 0.001). No significant differences between the groups were observed in readmissions or severe postoperative complications.CONCLUSIONS: Peroral antibiotic administration after laparoscopic appendectomy for complicated appendicitis significantly improves patient recovery and reduces hospital stay compared to intravenous antibiotics. These results advocate a potential shift towards peroral antibiotic use in postoperative care, aligning with ERAS principles.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04803422.
AB - BACKGROUND: Acute appendicitis is the most common cause of abdominal pain requiring surgery, usually managed with laparoscopic appendectomy. In Denmark, the standard postoperative treatment for complicated cases involves intravenous antibiotics. This study compares peroral versus intravenous antibiotics in the context of fast-track surgery and Enhanced Recovery After Surgery (ERAS) protocols. Our objective is to evaluate the impact of peroral versus intravenous antibiotics on patient-reported outcomes following laparoscopic appendectomy for complicated appendicitis.METHODS: This was a sub-study within a broader Danish cluster-randomized non-inferiority trial conducted at Zealand University Hospital, focusing on adult patients undergoing laparoscopic appendectomy for complicated appendicitis. Participants were randomized into two groups: one receiving a three-day course of peroral antibiotics and the other intravenous antibiotics after surgery. Recovery quality was assessed on the third postoperative day using the Quality of Recovery-15 (QoR-15) questionnaire.RESULTS: The study included 54 patients, 23 in the peroral and 31 in the intravenous groups. The peroral group reported significantly better recovery outcomes, with higher QoR-15 scores (mean difference of 12 points, p < 0.001). They also experienced shorter hospital stays, averaging 47 h less than the intravenous group (p < 0.001). No significant differences between the groups were observed in readmissions or severe postoperative complications.CONCLUSIONS: Peroral antibiotic administration after laparoscopic appendectomy for complicated appendicitis significantly improves patient recovery and reduces hospital stay compared to intravenous antibiotics. These results advocate a potential shift towards peroral antibiotic use in postoperative care, aligning with ERAS principles.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04803422.
KW - Humans
KW - Appendicitis/surgery
KW - Appendectomy/adverse effects
KW - Male
KW - Female
KW - Laparoscopy
KW - Adult
KW - Anti-Bacterial Agents/administration & dosage
KW - Administration, Oral
KW - Administration, Intravenous
KW - Middle Aged
KW - Cross-Over Studies
KW - Denmark
KW - Length of Stay
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85205973432&partnerID=8YFLogxK
U2 - 10.1007/s00423-024-03491-w
DO - 10.1007/s00423-024-03491-w
M3 - Journal article
C2 - 39379540
SN - 1435-2443
VL - 409
SP - 303
JO - Langenbeck's Archives of Surgery
JF - Langenbeck's Archives of Surgery
IS - 1
M1 - 303
ER -