2 days versus 5 days of Postoperative Antibiotics for Complex Appendicitis

To compare costs for 2 days versus 5 days of postoperative antibiotics within the Antibiotics following aPPendectomy In Complex appendicitis (APPIC) trial.Summary Background Data:Recent studies suggest that restrictive antibiotic use leads to a significant reduction in hospital stay without compromising patient safety. Its potential effect on societal costs remains underexplored.This was a pragmatic, open-label, multicenter clinical trial powered for non-inferiority. Patients with complex appendicitis (age ≥ 8 y) were randomly allocated to 2 days or 5 days of intravenous antibiotics after appendectomy. Patient inclusion lasted from June 2017 to June 2021 in 15 Dutch hospitals. Final follow-up was on September 1, 2021. The primary trial endpoint was a composite endpoint of infectious complications and mortality within 90 days. In the present study, main outcome measures were overall societal costs (comprising direct healthcare costs and costs related to productivity loss) and cost-effectiveness. Direct healthcare costs were recorded based on data in the electronic patient files, complemented by a telephone follow-up at 90 days. In addition, data on loss of productivity were acquired through the validated Productivity-Cost-Questionnaire at four weeks after surgery. Cost estimates were based on prices for the year 2019.In total, 1005 patients were evaluated in the Intention-to-Treat analysis: 502 patients allocated to the 2-day group and 503 to the 5-day group. The mean difference in overall societal costs was - € 625 (95% confidence interval - € 958 to - € 278) to the advantage of the 2-day group. This difference was largely explained by reduced hospital stay. Productivity losses were similar between the study groups. Restricting postoperative antibiotics to two days was cost-effective, with estimated cost savings of € 31,117 per additional infectious complication.2 days of postoperative antibiotics for complex appendicitis results in a statistically significant and relevant cost reduction, as compared with 5 days. Findings apply to laparoscopic appendectomy in a well-resourced healthcare setting.Trialregister.nl number NL5946.