WOFAPS 2025 8th World Congress of Pediatric Surgery

Rebecca Murphy Lonergan, Amelia Simenacz, Sharukh Zuberi, Jonathan Gosling, Subramaniam Gurunaidu, Venugopala Kalidindi

Royal Free London NHS Foundation Trust

National guidelines on paediatric appendicitis stipulate a pathway for the post-operative antibiotic management of acute appendicitis, stratified by intraoperative findings. Despite this, there is much variation in practice between surgeons and departments. Non-indicated post-operative antibiotics contribute to antibiotic resistance, C. difficile infection and longer inpatient hospital stay.

We assessed compliance with GIRFT guidelines on post-operative antibiotic prescribing in uncomplicated and complicated paediatric appendicitis. We then aimed to standardise practice in line with these national guidelines, to limit antibiotic prescribing to those patients who need it.

We conducted a retrospective review of paediatric appendicectomies (age <18 years on day of surgery) performed at four central London hospitals over a 3-month period. Initial findings were presented at department and site-wide governance events. A second prospective cycle was conducted following this. Specific educational based interventions were then held at each site, targeting junior colleagues most commonly responsible for prescribing. A third cycle is ongoing at the time of writing.

The average number of cases across all four sites was 21 (RANGE=13-33); most had pre-operative imaging to confirm the diagnosis. Retrospective rates of compliance with GIRFT guidelines ranged from 40-75% between hospitals. The most frequent non-compliant practice seen was the continuation of antibiotics following an uncomplicated appendicectomy, with a median duration of 6 days antibiotics post-op. Following education-based interventions, rates of compliance improved to 70-85% in subsequent cycles.

Rates of post-operative antibiotic prescribing in uncomplicated appendicitis were grossly discordant with national standards. The most effective intervention to improve compliance was prompting surgeons to specify a post-op antibiotic plan in the operation note and empowering junior doctors to challenge senior decisions to send patients home on oral antibiotics.

Frequent educational updates give clinicians the confidence to stop antibiotics in the post-op period when no longer indicated, saving costs and minimising harm.