Post Operative Wound Infection after Open Appendictomy in Surgery Department  CMH Rawalpindi

Hassan Mahmood Malik; Syeda Rifaat Qamar  Naqvi; Ayesha  .; Syed Hassan Tariq; Saqib  .; Fahd  Rashid

doi:10.51253/pafmj.v75iSUPPL-6.8398

Authors

Hassan Mahmood Malik Department of General Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Syeda Rifaat Qamar Naqvi Department of Gyne & Obs, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ayesha . Department of Gyne & Obs, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Syed Hassan Tariq Department of General Surgery, Combined Military Hospital Kohat/National University of Medical Sciences (NUMS) Pakistan
Saqib . Department of General Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Fahd Rashid Department of General Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-6.8398

Keywords:

Open appendectomy, Postoperative, Surgery, Wound infection

Abstract

Objective: To determine the frequency of post-operative wound infection after open appendectomy in surgery department of Combined Military Hospital Rawalpindi, Pakistan.

Study Design: Quasi-experimental study

Place and Duration of Study: Department of surgery, Combined Military Hospital, Rawalpindi, Pakistan from Jul to Dec 2021.

Patients and Methods: Patients aged 18 years and above of any gender of Diagnosed cases of acute appendicitis and undergoing open appendectomy were consecutively enrolled. Within 30 days following surgery, wound infection was defined as either incisional (superficial or deep) or organ/space wound infection.

Results: Of 122 patients, the overall wound infection was observed in 11(9%) patients. Of these 11 patients, incisional wound infection was observed in 7(63.6%) and organ/space wound infection in 6(54.5%) patients. The mean age of patients with no wound infection was considerably greater than that of patients with wound infection, i.e., 41.53±5.14 years and 37.27±5.58 years respectively (p-value 0.022). Diabetes (p-value: 0.006), IHD (p-value: 0.001), COPD (p-value: 0.039), 30 day rehospitalization (p-value: 0.001), ASA status (p value: 0.020), preoperative SIRS (p-value: 0.001), and wound classification (p value: 0.002) were all significantly higher in wound infection patients than in non-wound infection patients. Pulmonary infection 43(35.2%) was the most common postoperative complication.

Conclusion: Postoperative wound infection was observed in nine percent patients who underwent open appendectomy. Increased age, diabetes, IHD, COPD, preoperative SIRS, contaminated/dirty wound classification, and lower preoperative WBCs were significant risk factors.

Downloads

Download data is not yet available.

References

1. Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The Global Incidence of Appendicitis: A Systematic Review of Population-based Studies. Ann Surg. 2017; 266(2): 237-241. https://doi: 10.1097/SLA.0000000000002188.

2. Foster D, Kethman W, Cai LZ, Weiser TG, Forrester JD. Surgical site infections after appendectomy performed in low and middle human development-index countries: a systematic review. Surg Infect. 2018; 19(3): 237-244.

3. Danwang C, Bigna JJ, Tochie JN, Mbonda A, Mbanga CM, Nzalie RN, et al. Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis. BMJ Open. 2020; 10(2): e034266.

4. Labricciosa FM, Sartelli M, Barbadoro P, Abbo LM, Ansaloni L, Coccolini F, et al. Epidemiology and Risk Factors for Superficial Surgical Site Infections after Appendectomy for Acute Appendicitis: A Secondary Data Analysis. Surg Infect (Larchmt). 2021; 22(2): 227-233. https://doi: 10.1089/sur.2020.069.

5. Suh YJ, Jeong SY, Park KJ, Park JG, Kang SB, Kim DW, et al. Comparison of surgical-site infection between open and laparoscopic appendectomy. J Korean Surg Soc. 2012; 82(1): 35-39.

https://doi: 10.4174/jkss.2012.82.1.35.

6. Takami T, Yamaguchi T, Yoshitake H, Hatano K, Kataoka N, Tomita M, et al. A clinical comparison of laparoscopic versus open appendectomy for the treatment of complicated appendicitis: historical cohort study. Eur J Trauma Emerg Surg. 2020; 46(4): 847-851.

7. Sartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L, et al. Prospective observational study on acute appendicitis worldwide (POSAW). World J Emerg Surg. 2018; 13(1): 1-0.

8. Hussain MI, Alam MK, Al-Qahatani HH, Al-Akeely MH. Role of postoperative antibiotics after appendectomy in non-perforated appendicitis. J Coll Physicians Surg Pak. 2012; 22(12): 756-759.

9. Ibrahim T, Saleem MR, Aziz OB, Arshad A. Comparison of laparoscopic and open appendectomy in terms of operative time, hospital stay and frequency of surgical site infection. Pak Armed Forces Med J. 2014; 64(2): 196-198.

10. Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, et al. Surgical site infection after laparoscopic and open appendectomy: a multicenter large consecutive cohort study. Surg Endosc. 2015; 29(6): 1384-1393. https://doi: 10.1007/s00464-014-3809-y.

11. Robertson CM, Coopersmith CM. The systemic inflammatory response syndrome. Microbes Infect. 2006; 8(5): 1382-1389. https://doi: 10.1016/j.micinf.2005.12.016.

12. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999; 27(2): 97-132.

13. Koumu MI, Jawhari A, Alghamdi SA, Hejazi MS, Alturaif AH, Aldaqal SM. Surgical Site Infection Post-appendectomy in a Tertiary Hospital, Jeddah, Saudi Arabia. Cureus. 2021; 13(7): e16187. https://doi: 10.7759/cureus.16187.

14. Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML. Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infect Dis. 2008; 8: 34. 10.1186/1471-2334-8-34.

15. Aranda-Narváez JM, Prieto-Puga Arjona T, García-Albiach B, et al.: Post-appendectomy surgical site infection: overall rate and type according to open/laparoscopic approach. Enferm Infecc Microbiol Clin. 2014, 32: 76-81. 10.1016/j.eimc.2013.02.006

16. Marzouk M, Khater M, Elsadek M, Abdelmoghny A: Laparoscopic versus open appendectomy: a prospective comparative study of 227 patients. Surg Endosc. 2003, 17: 721-724. 10.1007/s00464-002-9069-2.

17. Garcell HG, Arias AV, Sandoval CA, García EG, Gamboa ME, Sado AB, Serrano RN: Incidence and etiology of surgical site Infections in appendectomies: a 3-year prospective study. Oman Med J. 2017, 32: 31-35. 10.5001/omj.2017.06

18. Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, et al. Surgical site infection after laparoscopic and open appendectomy: a multicenter large consecutive cohort study. Surg Endosc. 2015; 29(6): 1384-1393. https://doi: 10.1007/s00464-014-3809-y.

19. Nazir A, Farooqi SA, Chaudhary NA, Bhatti HW, Waqar M, Sadiq A. Comparison of Open Appendectomy and Laparoscopic Appendectomy in Perforated Appendicitis. Cureus. 2019; 11(7): e5105. https://doi: 10.7759/cureus.5105.

20. Langelotz C, Mueller-Rau C, Terziyski S, Rau B, Krannich A, Gastmeier P, et al. Gender-specific differences in surgical site infections: an analysis of 438,050 surgical procedures from the German National Nosocomial Infections Surveillance System. Viszeralmedizin. 2014; 30: 114-117. 10.1159/000362100

21. Watanabe A, Kohnoe S, Shimabukuro R, Yamanaka T, Iso Y, Baba H, et al. Risk factors associated with surgical site infection in upper and lower gastrointestinal surgery. Surg Today. 2008; 38(5): 404-412. https://doi: 10.1007/s00595-007-3637-y.

22. Morikane K. Epidemiology and risk factors associated with surgical site infection after different types of hepatobiliary and pancreatic surgery. Surg Today. 2017; 47: 1208-1214. 10.1007/s00595-017-1503-0.