Role of intraoperative antibiotics wound irrigation in reducing surgical site infection following open appendectomy: a randomized controlled trial.

BACKGROUND

Surgical site infection (SSI) is a common complication following open appendectomy, particularly in low and middle income countries. Intraoperative wound irrigation with antibiotic solutions has been used as a preventive strategy, though its efficacy remains debated.

OBJECTIVE

To evaluate the effectiveness of intraoperative wound irrigation using a combination of ceftriaxone and metronidazole in reducing SSIs after open appendectomy, compared to normal saline irrigation.

METHODS

A double-blind randomized controlled trial was conducted between July 2023 and December 2024 at Abu Ghraib General Hospital. A total of 410 patients aged 15-50 years with acute appendicitis undergoing open appendectomy were randomized into two groups. The experimental group received layer by layer irrigation with ceftriaxone and metronidazole, while the control group received saline irrigation. Postoperative follow-up was conducted on days 10, 15, and 30 to assess the incidence of SSIs using CDC criteria.

RESULTS

There was no statistically significant difference in SSI rates between the experimental and control groups (4.1% vs. 6.6%; p = 0.278). Among patients with perforated appendices, SSI rates remained statistically insignificant between the two groups. Preoperative CRP and WBC levels were significantly higher in patients who developed SSIs (p < 0.0001). No significant difference was observed in hospital stay duration between the groups.

CONCLUSION

Intraoperative wound irrigation with ceftriaxone and metronidazole did not significantly reduce SSI incidence compared to saline irrigation in open appendectomy. Routine use of antibiotic irrigation may not be justified.

TRIAL REGISTRATION

The study was retrospectively registered with the International Standard Randomised Controlled Trial Number (ISRCTN) registry under the registration number ISRCTN19878512 on 19 May 2025.