{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T18:45:19Z","timestamp":1793731519919,"version":"4.6.1"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"Importance<\/jats:title>Gangrenous, suppurative, and exudative (GSE) findings have been associated with increased surgical site infection (SSI) risk and resource use in children with nonperforated appendicitis. Establishing the role for postoperative antibiotics may have important implications for infection prevention and antimicrobial stewardship.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare SSI rates in children with nonperforated appendicitis with GSE findings who did and did not receive postoperative antibiotics.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a retrospective cohort study using American College of Surgeons\u2019 National Surgical Quality Improvement Program (NSQIP)\u2013Pediatric Appendectomy Targeted data from 16 hospitals participating in a regional research consortium. NSQIP data were augmented with operative report and antibiotic use data obtained through supplemental medical record review. Children with nonperforated appendicitis with GSE findings who underwent appendectomy between July 1, 2015, and June 30, 2020, were identified using previously validated intraoperative criteria. Data were analyzed from October 2022 to July 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Continuation of antibiotics after appendectomy.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Rate of 30-day postoperative SSI including both incisional and organ space infections. Complementary hospital and patient-level analyses were conducted to explore the association between postoperative antibiotic use and severity-adjusted outcomes. The hospital-level analysis explored the correlation between postoperative antibiotic use and observed to expected (O\/E) SSI rate ratios after adjusting for differences in disease severity (presence of gangrene and postoperative length of stay) among hospital populations. In the patient-level analysis, propensity score matching was used to balance groups on disease severity, and outcomes were compared using mixed-effects logistic regression to adjust for hospital-level clustering.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 958 children (mean [SD] age, 10.7 [3.7] years; 567 male [59.2%]) were included in the hospital-level analysis, of which 573 (59.8%) received postoperative antibiotics. No correlation was found between hospital-level SSI O\/E ratios and postoperative antibiotic use when analyzed by either overall rate of use (hospital median, 53.6%; range, 31.6%-100%; Spearman \u03c1\u2009=\u2009\u22120.10; P<\/jats:italic>\u2009=\u2009.71) or by postoperative antibiotic duration (hospital median, 1 day; range, 0-7 days; Spearman \u03c1\u2009=\u2009\u22120.07; P<\/jats:italic>\u2009=\u2009.79). In the propensity-matched patient-level analysis including 404 patients, children who received postoperative antibiotics had similar rates of SSI compared with children who did not receive postoperative antibiotics (3 of 202 [1.5%] vs 4 of 202 [2.0%]; odds ratio, 0.75; 95% CI, 0.16-3.39; P<\/jats:italic>\u2009=\u2009.70).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Use of postoperative antibiotics did not improve outcomes in children with nonperforated appendicitis with gangrenous, suppurative, or exudative findings.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2023.7754","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T16:01:33Z","timestamp":1707321693000},"page":"511","source":"Crossref","is-referenced-by-count":19,"title":["Postoperative Antibiotics, Outcomes, and Resource Use in Children With Gangrenous Appendicitis"],"prefix":"10.1001","volume":"159","author":[{"given":"Shannon 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Children\u2019s of Alabama; Department of Surgery, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Gerall","sequence":"additional","affiliation":[{"name":"Department of Surgery, UT Health San Antonio, San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia L.","family":"Griggs","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David N.","family":"Hanna","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia A.","family":"Keane","sequence":"additional","affiliation":[{"name":"Department of Surgery, Children\u2019s Healthcare of Atlanta, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron M.","family":"Lipskar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Cohen Children\u2019s Medical Center, Zucker School of Medicine at Hoftsra\/Northwell, New Hyde Park, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean E.","family":"McLean","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, University of North Carolina Health System, University of North Carolina School of Medicine, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Pace","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Santore","sequence":"additional","affiliation":[{"name":"Department of Surgery, Children\u2019s Healthcare of Atlanta, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Scholz","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelby R.","family":"Sferra","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins Children\u2019s Center, Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth T.","family":"Tracy","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke Children\u2019s Hospital and Health Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Yale New Haven Children\u2019s Hospital, Yale School of 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