title: Compliance with published recommendations for postoperative antibiotic management of children with appendicitis: A chart audit.
abstract: BACKGROUND
  Recommendations for postoperative antibiotics for appendicitis were published by the American Pediatric Surgical Association (APSA) in 2010. However, implementation of practice recommendations often takes years. We measured compliance of pediatric surgeons (who receive reminders every 6months from the Division Chief) with the APSA recommendations.
  
  
  METHODS
  With Research Ethics Board approval, we completed a retrospective review of children who underwent appendectomy since 2010. Compliance with APSA recommendations was analyzed descriptively. Agreement between pediatric surgeons and pathologists was analyzed by kappa.
  
  
  RESULTS
  We reviewed 242 charts. Patients were excluded for missing data (n=5) and diagnosis other than appendicitis (n=27), resulting in 210 patients with appendicitis (119 acute, 91 perforated). Agreement of perforation status between surgeons and pathologists was good (κ=0.75; 95% CI: 0.66-0.83). Many patients with nonperforated appendicitis received antibiotics in excess of the APSA recommendations (62/119 (52%)), as did those with uncomplicated perforated appendicitis (52/84 (62%)).
  
  
  CONCLUSIONS
  Despite the availability of published recommendations, surgeons continue to prescribe postoperative antibiotics for appendicitis in excess of the recommendations. Overtreatment leads to potential medication errors and increased length-of-stay/medication costs. An intensive implementation program with ongoing education/monitoring may improve compliance with established recommendations to decrease the use of excess postoperative antibiotics and their associated costs/risks.
authors.affiliation: Department of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada. Electronic address: annashawyer@gmail.com.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Shawyer
authors.affiliation: Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Hatchell
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Pemberton
authors.affiliation: Department of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Helene
authors.initials: H
authors.lastname: Flageole
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000592:standards*; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011184:Postoperative Period; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial stewardship; Appendicitis; Recommendations