Antibiotic Stewardship in Non-Perforated Gangrenous Appendicitis: Outcomes of Single-Dose versus Postoperative Therapy in a Retrospective Cohort Study

Abstract Purpose Nonperforated gangrenous appendicitis (NGA) is a severe inflammatory condition without perforation, and the optimal duration of postoperative antibiotic therapy remains debated. This study aimed to compare outcomes between single-dose antibiotic therapy (SDAT) and postoperative antibiotic therapy (POAT). Methods This retrospective cohort study compared outcomes among 242 adult patients diagnosed histopathologically with NGA after laparoscopic appendectomy who received SDAT versus POAT antibiotics. Demographic characteristics, clinical scores, inflammatory biomarkers, antibiotic regimens, and postoperative surgical infectious complications (PSCs) within 30 days were evaluated. Results Among the cohort, 68.2% received SDAT and 31.8% received POAT. SDAT was associated with significantly shorter hospital stays (14 vs. 79 hours; p < 0.001) without an increased rate of postoperative complications compared with POAT (3.6% vs. 11.7%; p = 0.022). Intra-abdominal abscess and surgical site infection rates were low and showed no meaningful difference between groups. Patients receiving POAT tended to have higher baseline risk markers, including older age, elevated CRP, and higher ASA and q-SOFA scores, reflecting surgeons’ clinical judgment rather than histopathological severity. Conclusions These findings support that extended postoperative antibiotics may not provide additional benefit in stable NGA patients. However, given the retrospective design, causal inference is limited, and prospective risk-adjusted studies are warranted.