Surgical Site Infection Post-appendectomy in a Tertiary Hospital, Jeddah, Saudi Arabia

Koumu, Mohammed I; Jawhari, Abdulkarim A.; Alghamdi, Saleh A.; Hejazi, Mutasem S.; Alturaif, Ali H.; Aldaqal, Saleh M.

doi:10.7759/cureus.16187

Cited by 9 publications

(11 citation statements)

References 28 publications

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“…Those who undergo laparotomy have three times the risk of SSI compared to laparoscopic appendectomy. Similar findings were reported in a local study in Saudi Arabia, which found that SSI had significantly higher odds among laparotomy patients (OR=4.11) [ 12 ]. Furthermore, a systematic review found that the pooled SSI incidence was 17.9/100 open laparotomies compared to 8.8/100 laparoscopic appendectomies [ 7 ].…”

Section: Discussionsupporting

confidence: 89%

Risk Factors for Post-appendectomy Surgical Site Infection in Laparoscopy and Laparotomy - Retrospective Cohort Study

Fayraq,

Alzahrani,

Alsayaf Alghamdi

et al. 2023

Cureus

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Background Appendicitis is a frequent emergency condition. Surgical site infections (SSI) are a common complication of appendectomy. Despite improvements in infection control, SSIs continue to cause harm, prolonged hospital stays, and even death. Objective The objective of this study is to compare the risk of developing surgical site infections (SSIs) between open laparotomy and laparoscopic appendectomies in Al-Baha, Saudi Arabia. Methods This retrospective cohort study compared laparotomy and laparoscopy for post-operative surgical site infection among patients who underwent an appendectomy at King Fahad Hospital (KFH) in Albaha, Saudi Arabia. Medical record numbers (MRNs) of patients who met the inclusion criteria were collected to build the sampling frame. From the final sampling frame, simple random sampling using a random number generator was used to draw a representative sample. Data were collected from the surgical health records of the patients. The collected data included patients' demographics, comorbidities, presenting symptoms, ordered imaging studies, pre-operative shaving, type and duration of surgery, intraoperative findings, and signs of wound inflammation. Results The total number of patients included in the analysis was 256, who underwent surgery for acute appendicitis. Among those who underwent laparoscopy, 5.7% had to be converted to open laparotomy. Signs of surgical wound inflammation were found in 10.2% of the patients. Patients who underwent open laparotomy had a significantly higher risk of wound infection (RR=3.1, p-value=0.001). Further analysis revealed an effect modification of pre-operative shaving. Open laparotomy has a higher risk of wound infection among patients who have not had pre-operative shaving (RR=4.1 vs. RR=2.6), while both risks were statistically significant (p-value=0.033 and p-value=0.035), respectively. Complicated cases in intra-operative findings were found to have a higher risk of post-appendectomy SSI. Conclusion This study demonstrates that laparoscopic appendectomy carries a lower risk of surgical site infection (SSI) compared to open laparotomy. Additionally, pre-operative shaving of the surgical site was found to increase the incidence of SSI. Healthcare providers can use this information to enhance their practice and reduce the occurrence of surgical site infections. Whenever possible, laparoscopic appendectomy should be preferred over open laparotomy due to its substantially lower SSI risk. We also recommend vigilant monitoring of complicated appendectomy, particularly in cases of ruptured appendicitis, for signs of SSI.

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Section: Discussionsupporting

confidence: 89%

Risk Factors for Post-appendectomy Surgical Site Infection in Laparoscopy and Laparotomy - Retrospective Cohort Study

Fayraq,

Alzahrani,

Alsayaf Alghamdi

et al. 2023

Cureus

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“…In one local review, SSI postappendectomy was found in 31 patients out of 433 (7%) [ 31 ]. Our data showed SSI in 26 patients (5.8%) and deep-spaced collection identified in 13 patients (2.9%) managed by CT-guided drainage.…”

Section: Discussionmentioning

confidence: 99%

Complicated appendicitis increases the hospital length of stay

Alotaibi

Alfawaz

Felemban

et al. 2022

Surgery Open Science

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“…A great practice is earned by surgeons during the two world wars in dealing with contaminated wounds and applying DPC of such wounds after being healthy at day 3-7 following surgery was fixed [19]. Increasing the severity of the appendicitis being operated on leads to increase the rate of postoperative SSI following appendicectomy, and the majority of wound infections occurs following appendicectomy for complicated appendicitis [20]. The wounds of these dirty operations are essentially contaminated.…”

Section: Discussionmentioning

confidence: 99%

Primary Closure or Delayed Primary Closure? Assessment of Optimum Management of Surgical Wounds for Perforated Appendicitis

Fuad

Modher

2022

Open Access Maced J Med Sci

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BACKGROUND: Open appendectomy is the treatment of choice for perforated appendicitis. Perforated appendicitis is associated with a 15–20% risk of developing post-operative wound infection, which the later associated with increased morbidity as increasing post-operative pain, longer hospital stay, suppurative wounds, patient dissatisfaction and increase cost of treatment. Some literatures revealed inconsistent results related to the incidence of surgical site infection (SSI) between delayed primary closures (DPC) and primary closure (PC) in open appendectomy for perforated appendicitis. AIM: The objective of the study is to define the best practice of wound management in patients operated on for perforated appendicitis. PATIENTS AND METHODS: One hundred and twenty patients having perforated appendicitis underwent open appendectomy enrolled in the study. The patients were randomly grouped according to the method of managing the surgical incisions into two groups; patients with their incisions closed primarily (PC) and those with their incisions left open to be frequently dressed for 5 days with Betadine-soaked gauze packing till it become clean then closed (DPC). An infected wound was assigned as such if purulent discharge yielded from the incision site. Results to be addressed were the incidence of SSI and the hospitalization length. RESULTS: Out of the total 120 patients, 19.17 % developed SSI following closure of the incision. Patients managed by PC revealed higher rate of SSI than DPC group (32.8% vs. 5.1%, p < 0.001) and longer hospitalization (8.3 vs. 6.4 days, with a p < 5%). CONCLUSION: DPC is preferred policy over PC when managing an open appendicectomy wounds for perforated appendicitis, as the former is associated with low incidence of wound infection and shorter hospitalization.

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Surgical Site Infection Post-appendectomy in a Tertiary Hospital, Jeddah, Saudi Arabia

Cited by 9 publications

References 28 publications

Risk Factors for Post-appendectomy Surgical Site Infection in Laparoscopy and Laparotomy - Retrospective Cohort Study

Risk Factors for Post-appendectomy Surgical Site Infection in Laparoscopy and Laparotomy - Retrospective Cohort Study

Complicated appendicitis increases the hospital length of stay

Primary Closure or Delayed Primary Closure? Assessment of Optimum Management of Surgical Wounds for Perforated Appendicitis

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