Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis

Abstract

BackgroundAlthough surgical site infection (SSI) is one of the most studied healthcare-associated infections, the global burden of SSI after appendectomy remains unknown.ObjectiveWe estimated the incidence of SSI after appendectomy at global and regional levels.DesignSystematic review and meta-analysis.ParticipantsAppendectomy patients.Data sourcesEMBASE, PubMed and Web of Science were searched, with no language restrictions, to identify observational studies and clinical trials published between 1 January 2000 and 30 December 2018 and reporting on the incidence of SSI after appendectomy. A random-effect model meta-analysis served to obtain the pooled incidence of SSI after appendectomy.ResultsIn total, 226 studies (729 434 participants from 49 countries) were included in the meta-analysis. With regard to methodological quality, 59 (26.1%) studies had low risk of bias, 147 (65.0%) had moderate risk of bias and 20 (8.8%) had high risk of bias. We found an overall incidence of SSI of 7.0 per 100 appendectomies (95% prediction interval: 1.0–17.6), varying from 0 to 37.4 per 100 appendectomies. A subgroup analysis to identify sources of heterogeneity showed that the incidence varied from 5.8 in Europe to 12.6 per 100 appendectomies in Africa (p<0.0001). The incidence of SSI after appendectomy increased when the level of income decreased, from 6.2 in high-income countries to 11.1 per 100 appendectomies in low-income countries (p=0.015). Open appendectomy (11.0 per 100 surgical procedures) was found to have a higher incidence of SSI compared with laparoscopy (4.6 per 100 appendectomies) (p=0.0002).ConclusionThis study suggests a high burden of SSI after appendectomy in some regions (especially Africa) and in low-income countries. Strategies are needed to implement and disseminate the WHO guidelines to decrease the burden of SSI after appendectomy in these regions.Prospero registration numberCRD42017075257.

Thickness of subcutaneous fat is a risk factor for incisional surgical site infection in acute appendicitis surgery: a prospective study

“…First, the prevalence of incisional SSI in our patient population was 13.3%, which is slightly over half of the prevalence of SSI following abdominal surgery reported in our center in 2011 [23]. A recent meta-analysis assessed that, while the global overall incidence of SSI after appendectomy was 7.0%, the incidence of SSI was higher in low-income countries (11.1%; compared to high-income countries: 6.2%) and open appendectomy (11.0%; compared to laparoscopic appendectomy: 4.6%) [6]. Further, a systematic review that focused on low and middle Human Development-Index Countries reported the overall SSI rate was 17.9% in open appendectomy [7], thus the rate of SSI in our patient population was consistent with these two studies.…”

“…SSI, including incisional SSI and organ/space SSI, is the most frequent postoperative complication of acute appendicitis, which is a common surgical emergency worldwide [5]. Several systematic reviews have noted that there is a higher burden of SSI in low-income countries [1,6]. SSI is especially common after open appendectomy, which remain the most common surgical approach for acute appendicitis in low-income countries [7].…”

A Single Dose of Antibiotics in Laparoscopic Appendicectomy

“…The most common problem after appendicectomy is surgical site infection. [2,3] The Center for Disease Control and Prevention (CDC) also identified basic guidelines for surgical site infections. Throughout laparoscopic surgery, the risk of infection occurs when the skin becomes incised and the first natural layer is removed, but the highest risk of infection is at the moment of tissue processing, which may also contribute to post-operative infection.…”

The role of postoperative antibiotics in preventing surgical site infections in uncomplicated appendicitis

“…Post appendicectomy SSIs is one of the common adverse events affecting patient safety worldwide [ 8 ]. Preoperative antibiotic therapy is a well-established and evidence-based practice which was found to be efficient to decrease the incidence of postoperative SSIs [ 9 ].…”