Evaluating the necessity of post-operative antibiotics in uncomplicated appendicitis: a systematic review and meta-analysis.

INTRODUCTION: Acute appendicitis is a common surgical emergency worldwide. While the use of preoperative antibiotics has shown clear benefits in improving outcomes for uncomplicated appendicitis, the necessity of routine postoperative antibiotics remains a topic of debate. This meta-analysis evaluates the impact of preoperative and postoperative antibiotics on patient outcomes, adverse events, and hospital stay duration. METHODOLOGY: A systematic review and meta-analysis were conducted, including 14 studies published over the past 15 years, focusing on patients aged 14-65 with uncomplicated appendicitis. Both experimental and observational designs were included. Statistical analyses were performed using SPSS, Excel, and RevMan to assess adverse effects, hospital stays, and antibiotic duration outcomes. The risk of bias was assessed using the Cochrane tool, with all included studies showing low risk across key domains. The study received no external funding and was not registered in any clinical trial database. RESULTS: Preoperative antibiotic prophylaxis demonstrated significant benefits, including shorter hospital stays and reduced postoperative complications. Metronidazole was the most frequently prescribed antibiotic, followed by cefoxitin and cefuroxime. Conversely, the use of postoperative antibiotics was associated with increased rates of adverse events, including Clostridium difficile infections, deep surgical site infections, and urinary tract infections. Patients receiving only preoperative antibiotics experienced fewer complications and improved overall outcomes than those receiving postoperative antibiotics. CONCLUSION: Preoperative antibiotics, such as metronidazole and cefoxitin, are sufficient to optimize outcomes in uncomplicated appendicitis. Postoperative antibiotics offer no additional benefit and are associated with a higher risk of adverse events. These findings support limiting antibiotic use to the preoperative phase, aligning with antimicrobial stewardship principles, and ensuring safer, more cost-effective patient care. A revision of clinical guidelines is recommended to reflect these findings and enhance evidence-based practices in managing uncomplicated appendicitis. Despite some heterogeneity in study design and follow-up variability, this meta-analysis remains robust due to consistent inclusion criteria, high-quality studies, a large sample size, and rigorous methods like the Mantel-Haenszel model.