Background/Knowledge Gap: Antibiotics within an hour of incision have been shown to reduce incidence of surgical site infection (SSI) in clean-contaminated abdominal surgery. Patients undergoing emergency surgery often receive treatment antibiotics in the emergency department and may not benefit from additional pre-incisional antibiotics. To date, no study has examined pre-incision cefazolin’s efficacy in the case of emergency intra-abdominal procedures, particularly in the case where broad-spectrum coverage was administered in the emergency department prior to surgery. We hypothesized that additional preoperative cefazolin does not decrease incidence of SSI in emergency appendectomies in patients previously treated with broad spectrum antibiotics in the emergency department.

Methods/Design: We evaluated outcomes of patients before and after a policy change recommending pre-incision cefazolin irrespective of ongoing antimicrobial therapy. All adult patients at a single institution undergoing emergency appendectomies for acute appendicitis between 2013 and 2020 were included. Age, sex, perforation, body mass index (BMI), Elixhauser comorbidity index (ECI), surgical approach, emergency department antibiotics (EDA), and preoperative antibiotics were abstracted. Primary outcomes were superficial/deep and organ-space SSIs. Bivariable and multivariable logistic regression models assessed the independent impact of each strategy. Multivariable models compared those receiving pre-incision cefazolin to those receiving no pre-incision antibiotics

Results/Findings: Patients (n= 1328) had a mean age (SD) of 39.5 (17.0) years and 40% were female. Age, sex, perforated appendicitis, EDA, ECI and BMI all were predictive of infection. After adjustment for age, sex, perforation, EDA, ECI and BMI, ED broad spectrum antibiotics were associated with lower incidence of superficial/deep infection [OR 0.06 95% CI (0.00 – 0.68)] however pre-incision cefazolin was not [OR 0.71 95% CI (0.08 – 15.34)].

Conclusions/Implications: For patients undergoing emergency appendectomy who have received broad spectrum antibiotic treatment in the emergency department, additional pre-incision cefazolin may not reduce the incidence of superficial/deep or organ-space SSI. As the antibiotic resistance epidemic continues to be a major problem within the healthcare system, finding opportunities to limit the administration of unnecessary antibiotics is both valuable and necessary in combating resistance.

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