Da Wei Thong
Gold Coast University Hospital, Gold Coast, Australia
Dr Da Wei Thong completed his medical degree (MBBS) at Monash University, Australia in 2013. Dr Thong is currently pursuing a Master (MSc) in Surgical Sciences with University of Edinburgh, UK and is in his final year of study. He is currently working as an unaccredited surgical registrar at Gold Coast Health, Australia. His main clinical interests lie in General Surgery. He is affiliated with Griffith University as a lecturer to medical students and is an active advocate of surgical research works. He had previously published and presented in conferences in Asia.
The primary outcome is to investigate surgeons’ compliance to antibiotics guidelines for management of appendicitis in Australia peri and postoperatively, with the secondary outcome looking at predictors of post-operative complication; surgical site infection(SSI) and intra-abdominal abscess in 30 days.
A multicentre, prospective, observational study was conducted in a period of 2 months between June and October 2016. A database with prefilled variables are completed by each local principal investigators with a protocol guidance. Patients whom underwent laparoscopy with the intention of appendicectomy were recruited in the study.
A total of 1189 patients were recruited. Therapeutic guidelines antibiotic version 15 (Australian Clinical Practice Guidelines, 2014) is used to compare compliance. Guidelines endorses all patients receive antibiotics peri-operatively; 1081(92.1%) received antibiotics in this study. The rate of peri-operative antibiotic use increases with the severity of appendicitis. Highest use was in the gangrenous group, 81(98.1%) followed by complicated, 191(93.2%) and non-appendicitis, 156(85.7%). 593(51.0%) and 379(32.6%) patients received post-operative intravenous(IV) and oral antibiotics respectively. Following simple appendicectomy, only 391(56.6%) patients did not receive post-operative antibiotics as per guidelines. However, in gangrenous and complicated appendicitis, it is reassuring to see 89(98.9%) and 198(97.1%) patients received antibiotics post-operatively. Aboriginal and Torres-Strait-Islander(5.5x) and laparoscopy converted open appendicectomy(9.5x) increases the odds of SSI. This is also statistically significant post multivariable logistic analysis (p<0.05). Complicated appendicitis, operated by senior surgeon and received IV or oral antibiotics post-operatively increases the odds of intra-abdominal abscess.
We recommend more awareness and implementation are required for antibiotics prescription guidelines for optimal management of appendicitis in Australia.