Effects of different antibiotic strategies on postoperative inflammatory response and recovery in patients with acute appendicitis: a single-center, prospective, randomized controlled study

To evaluate the impact of different antibiotic regimens on postoperative outcomes in patients with acute appendicitis and assess the predictive value of preoperative procalcitonin (PCT) for postoperative fever. This prospective randomized controlled trial enrolled patients with acute uncomplicated appendicitis. Participants were randomly assigned to three groups: no antibiotics, single preoperative dose, or full-course antibiotics (preoperative dose plus 3 days postoperative). Inflammatory markers, pain scores, length of stay, and complications were compared. ROC analysis assessed PCT’s predictive value for fever. Of 437 randomized patients, baseline characteristics were comparable. No significant differences were observed among groups in postoperative inflammatory markers (POD1 and POD3), length of hospital stay, pain scores, or complication rates (all P > 0.05). Preoperative PCT demonstrated excellent predictive value for postoperative fever (AUC = 0.852, sensitivity 76.2%, specificity 88.5%). Omitting perioperative antibiotics did not compromise outcomes in laparoscopic appendectomy for uncomplicated appendicitis. Preoperative PCT effectively predicts postoperative fever, aiding clinical decision-making for antibiotic use. : Chinese Clinical Trial Registry, ChiCTR2000032410. Registered on May 8, 2020.