Perforated Appendicitis and Postoperative Antibiotics Pilot Trial

Acute appendicitis, a sudden and severe inflammation of the appendix, is the most commonemergency general surgery condition worldwide. In some cases, the appendix perforates,leading to contamination or infection within the abdominal cavity. Complicatedappendicitis is associated with higher morbidity and mortality, including a higher riskof surgical site infections (SSIs). Approximately 20% of patients with complicatedappendicitis develop an SSI, compared to about 5% of patients with uncomplicatedappendicitis.The use of antibiotics before surgery is well established and standard practice to reduceSSI risk. However, there is limited evidence to guide the use of antibiotics aftersurgery in patients with complicated appendicitis. Antibiotics carry potential risks,including allergic reactions, gastrointestinal side effects, and secondary infections,and their overuse contributes to antimicrobial resistance, which is a growing globalhealth concern. As a result, there is a considerable variation in clinical practice, withsome surgeons routinely prescribing post‐operative antibiotics and others choosing notto.Large, high‐quality randomized controlled trials (RCTs), the gold‐standard in clinicalresearch, are needed to understand if post‐operative antibiotics are necessary in thispopulation. The current study will evaluate the impact of post‐operative antibiotics onSSIs in patients with perforated appendicitis. This pilot specifically aims to determinethe feasibility of a larger, multi‐centre RCT, and will assess our ability to enroll andrandomize patients, and to collect complete health data using an existing framework.Patients will be randomly assigned to receive post‐operative antibiotics or nopost‐operative antibiotics after surgery for perforated appendicitis, and will befollowed until 30 days after surgery to assess incidence of SSIs, with additionaloutcomes collected up to 90 days post‐surgery.