TPT 3.15 When Less Is More: Rethinking the use of Intra-abdominal Drains, Lavage, and Antibiotics in Emergency Appendicectomy

Abstract

Current evidence discourages routine insertion of intra-abdominal drains after appendicectomy. The role of post-operative antibiotics and intra-abdominal lavage remains controversial. This study evaluated the impact of drain and antibiotic usage in emergency appendicectomy at a district general hospital. A retrospective cohort study included all patients with suspected appendicitis during 2022–2024. Operated patients were analysed by drain use, lavage volume, antibiotic duration, and intra-operative disease severity (simple vs complicated), with complicated cases stratified by contamination. Post-operative complications were graded using the Clavien–Dindo (CD) system, with severe complications defined as CD ≥ III. Follow-up extended to one year. Owing to low event rates, analyses were descriptive, with Fisher’s exact test applied where appropriate. Of 620 patients, 506 underwent emergency appendicectomy (98.4% laparoscopic). Drains were used in 116 (22.9%) patients. Drain usage was uncommon in mild appendicitis (11 of 326 patients; 3.37%) but occurred in 105 of 180 (58%) patients with complicated appendicitis. Post-operative complications were rare, with seven severe complications, including two CD IV events and one death. Drain insertion was associated with higher rate of severe complications (p = 0.008) and prolonged hospital stay, though this association was inconsistent across disease severity subgroups. No reduction in complications was observed with increased lavage volume or prolonged antibiotic therapy. Routine use of drains, lavage, or prolonged antibiotics did not improve outcomes. Drain use reflected disease severity rather than a strategy to reduce complications. These findings support a selective, rather than routine, approach to adjunctive interventions in emergency appendicectomy.