TPTh 4.03 Improving Antimicrobial Stewardship in Acute Appendicitis Through Education and System-Level Documentation Redesign: A Closed-Loop Audit at Wirral University Teaching Hospital NHS Trust
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2026
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Abstract
Abstract Aim To assess adherence to World Society of Emergency Surgery (WSES) 2020 guidelines in the management of acute appendicitis, focusing on post-operative antibiotic prescribing and intra-operative documentation, and to evaluate the impact of targeted educational and system-level interventions Methods A closed-loop audit was conducted across two cycles. The first cycle included patients undergoing laparoscopic appendicectomy over a six-month period. Compliance with WSES-recommendations regarding post-operative antibiotic use and duration, intra-operative documentation of disease severity and contamination, and microbiological sampling was assessed. Findings were presented locally and informed consultant-led education and the development of a revised electronic laparoscopic appendicectomy theatre note designed to embed guideline-based prompts within the documentation workflow. A second audit cycle evaluated early changes in prescribing behaviour and documentation practices following these interventions, prior to full system-wide implementation. Results Eighty-one patients were included in cycle one and 31 in cycle two. The re-audit demonstrated early changes in antibiotic prescribing, with reduced duration in complicated appendicitis (9.2 to 8.4 days). Ongoing variation in prescribing for uncomplicated appendicitis was identified. Selective fluid culture sampling in high-risk cases yielded positive microbiology in all samples. Improved data capture supported refinement of discharge planning and antimicrobial stewardship. Negative appendicectomy rates remained low-6.5% Conclusions This audit demonstrates that combining education with early system development can support improved antimicrobial stewardship in acute appendicitis. The development of an electronic documentation tool embedding guideline-based prompts represents a sustainable strategy to reduce practice variation. Ongoing evaluation will assess the impact of full implementation on guideline adherence and patient outcomes.
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| Authors | Anudeep Ladi, Muneeba Mustafai, Katherine Buckley |
| Journal | the british journal of surgery |
| Year | 2026 |
| DOI |
10.1093/bjs/znag087.455
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| Keywords | Keywords not found |
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