Risk Factors and Outcomes for Septic Complications After Laparoscopic Appendectomy

Abstract

Purpose: The aim of the study is to investigate the postoperative infectious complications after laparoscopic appendectomy of patients with acute appendicitis in UMHATEM "N.I.Pirogov". Material and Methods: For a period of one year from 1.1.2018 to 31.12.2018. a total of 218 patients with acute appendicitis were operated in the General, Visceral and Emergency Surgery Department of UMHATEM "Pirogov". Of these, 143 were laparoscopic apendectomy. Indicators characterizing basic clinical and pathological features (epidemiology, demography, degree of pathological disability), surgical approach and outcomes (postoperative complications, duration of the postoperative period) were analyzed. Results: Of the 143 of the patients- women are 79 (55.24%), male -51 (44.76%). The age of the patients varies from 18 to 79 years. The laparoscopy time interval is 21-117min., and in some cases, with a prolonged operation, the conversions are included. The hospital stay ranged from 2 to 8 days. Postoperative complications were recorded in 13 cases (9.09%) - wound infection in nine (treated with VAC dressing), two patients with (0.92%) intra-abdominal abscess (PTC drained) and other 2-with ileus (with conservative treatment). Conclusion: Aggressive manipulations on infected appendix and irregular lavage can spread bacterial contamination. Compliance with standardized laparoscopic appendectomy rules and systematized training of specialists will significantly improve postoperative results.

Risk factors for postoperative morbidity, prolonged length of stay and hospital readmission after appendectomy for acute appendicitis

“…These results are consistent with previous data from Lee et al, although a longer LOS was only observed comparing complicated appendicitis and negative appendectomy [18]. The overall complication rate after appendectomy for acute appendicitis in our study was 6% and therefore consistent with previous data from literature [10][11][12][13][14]. We could identify six independent risk factors for morbidity: higher age, higher preoperative WBC count, higher preoperative CRP, lower preoperative hemoglobin, longer time to surgery and longer duration of surgery.…”

“…In our cohort, about half of patients with postoperative complications had major morbidity (Clavien-Dindo III-V). This rate was slightly higher than those reported in literature [11,12,14,21,23]. On the other side, mortality was 0.13% in our study group, which is lower than reported by two big European analysis with over 100,000 patients (mean mortality of 2.1-2.4 per 1000 patients) [24,25].…”

“…13.4 ± 1.9 < 0.001 14.3 ± 1.5 31 (31) 442 (29) 15 (30) 382 (28) 75 (36) 450 (29) 7 (23) > 12 h-≤ 24 h 262 (18) 16 (16) 272 (18) 6 (12) 246 (18) 32 (15) 274 (18) 4 (13) > 24 h 127 (9) 15 (15) 130 (9) 12 (24) 115 ( 8 stay compared to appendectomies for acute appendicitis and with a low morbidity (3%) in our study. These results are consistent with previous data from Lee et al, although a longer LOS was only observed comparing complicated appendicitis and negative appendectomy [18].…”

“…1 3 However, until now prompt appendectomy may be still the therapy of choice for most patients with acute appendicitis [8,9]. Moreover, previous studies show moderate morbidity rates after appendectomy between six and nine percent [10][11][12][13][14].…”