Fayraq Amer, Alzahrani Saif A, Alsayaf Alghamdi Ahmed G, Alzhrani Saleh M, Alghamdi Abdullmajeed A, Abood Hashem B
Preventive Medicine, King Abdullah International Medical Research Centre, Jeddah, SAU.
Preventive Medicine, King Abdulaziz Medical City, Jeddah, SAU.
Cureus. 2023 Aug 28;15(8):e44237. doi: 10.7759/cureus.44237. eCollection 2023 Aug.
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.
阑尾炎是一种常见的急症。手术部位感染（SSI）是阑尾切除术的常见并发症。尽管感染控制有所改善，但SSI仍会造成伤害、延长住院时间甚至导致死亡。目的：本研究的目的是比较沙特阿拉伯巴哈地区开腹阑尾切除术和腹腔镜阑尾切除术发生手术部位感染（SSI）的风险。方法：这项回顾性队列研究比较了沙特阿拉伯巴哈法赫德国王医院（KFH）接受阑尾切除术患者中开腹手术和腹腔镜手术术后手术部位感染情况。收集符合纳入标准患者的病历号（MRN）以构建抽样框架。从最终抽样框架中，使用随机数生成器进行简单随机抽样以抽取具有代表性的样本。从患者的手术健康记录中收集数据。收集的数据包括患者的人口统计学信息、合并症、出现的症状、安排的影像学检查、术前备皮、手术类型和持续时间、术中发现以及伤口炎症迹象。结果：纳入分析的患者总数为256例，均接受了急性阑尾炎手术。在接受腹腔镜手术的患者中，5.7%不得不转为开腹手术。10.2%的患者出现手术伤口炎症迹象。接受开腹阑尾切除术的患者伤口感染风险显著更高（RR = 3.1，p值 = 0.001）。进一步分析显示术前备皮存在效应修正。未进行术前备皮的患者中，开腹阑尾切除术的伤口感染风险更高（RR = 4.1对比RR = 2.6），而两种风险均具有统计学意义（p值分别为0.033和0.035）。术中发现的复杂病例阑尾切除术后发生SSI的风险更高。结论：本研究表明，与开腹阑尾切除术相比，腹腔镜阑尾切除术的手术部位感染（SSI）风险更低。此外，发现手术部位术前备皮会增加SSI的发生率。医疗服务提供者可利用这些信息改进其操作并减少手术部位感染的发生。只要有可能，由于腹腔镜阑尾切除术的SSI风险显著更低，应优先选择该术式而非开腹阑尾切除术。我们还建议对复杂阑尾切除术，特别是阑尾破裂的病例，密切监测SSI迹象。
