1887
Volume 2024, Issue 4
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Surgical site infections (SSIs) after appendectomies constituted a significant patient safety issue and impacted the efficiency of healthcare. Various risk factors had been linked to SSI after appendectomies, including risk to patients and procedures, and compliance with infection control practices. This study aimed at identifying the risk factors for SSI in appendectomies due to acute appendicitis in a single facility in Qatar.

A historical observational study of appendectomies performed from January 2013 to February 2023 at a single facility in Qatar was conducted. Demographics, surgical procedure data, compliance with antibiotic prophylaxis, and histopathological findings were recorded from the patient’s electronic medical records.

A total of 2377 appendectomies and 52 SSIs were described, mainly in male patients (93.3%) with a mean age of 32.4 years and non-complicated appendicitis (66.7%). SSI risk was 3.86 times higher when appendicitis was perforated in comparison to other appendicitis types [odds ratio (OR) = 3.86; 95% confidence interval (95% CI) OR 1.93–7.70]. Procedures longer than 81 minutes had 4.84 times more SSI risk (OR = 4.84; 95% CI 2.25–10.42), the improper timing of antibiotic prophylaxis had 5.97 times higher SSI risk (OR = 5.97; 95% CI 1.10–32.56), and the improper antibiotic selection had 9.08 times higher SSI risk (OR = 9.08; 95% CI 1.81–45.42).

This study identifies the risk factors linked to SSI risk, including perforated appendectomies, longer surgical procedures, and improper timing and selection of antibiotic prophylaxis. The infection control program should focus on interventions to improve compliance with antibiotic prophylaxis and evaluate additional strategies to minimize the SSI risk in complicated appendicitis.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2024.18
2024-06-06
2024-06-19
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2024/4/jemtac.2024.18.html?itemId=/content/journals/10.5339/jemtac.2024.18&mimeType=html&fmt=ahah

References

  1. Yang L, Zheng R, Li H, Ren Y, Chen H. The burden of appendicitis and surgical site infection of appendectomy worldwide. J Infect Dev Ctries. 2023; 17:(3):367–73. https://doi.org/10.3855/jidc.17145
    [Google Scholar]
  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 (Larchmt). 2018; 19:(3):237–44. https://doi.org/10.1089/sur.2017.188
    [Google Scholar]
  3. Schreiber PW, Sax H, Wolfensberger A, Clack L, Kuster SP, Swissnoso. The preventable proportion of healthcare-associated infections 2005–2016: systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2018; 39:(11):1277–95. https://doi.org/10.1017/ice.2018.183
    [Google Scholar]
  4. Strobel RM, Leonhardt M, Förster F, Neumann K, Lobbes LA, Seifarth C, et al. The impact of surgical site infection-a cost analysis. Langenbecks Arch Surg. 2022; 407:(2):819–28. https://doi.org/10.1007/s00423-021-02346-y
    [Google Scholar]
  5. Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017; 96:(1):1–15. https://doi.org/10.1016/j.jhin.2017.03.004
    [Google Scholar]
  6. Monahan M, Jowett S, Pinkney T, Brocklehurst P, Morton DG, Abdali Z, et al. Surgical site infection and costs in low- and middle-income countries: a systematic review of the economic burden. PLoS One. 2020; 15:(6):e0232960. https://doi.org/10.1371/journal.pone.0232960
    [Google Scholar]
  7. 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.org/10.7759/cureus.16187
    [Google Scholar]
  8. Ingraham AM, Cohen ME, Bilimoria KY, Pritts TA, Ko CY, Esposito TJ. Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery. 2010; 148:(4):625–35;discussion 635–7. https://doi.org/10.1016/j.surg.2010.07.025
    [Google Scholar]
  9. Danwang C, Bigna JJ, Tochie JN, Mbonda A, Mbanga CM, Nzalie RNT, et al. Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis. BMJ Open. 2020; 10:(2):e034266. https://doi.org/10.1136/bmjopen-2019-034266
    [Google Scholar]
  10. Rosenthal VD, Richtmann R, Singh S, Apisarnthanarak A, Kübler A, Viet-Hung N, et al. Surgical site infections, International Nosocomial Infection Control Consortium (INICC) report, data summary of 30 countries, 2005-2010. Infect Control Hosp Epidemiol. 2013; 34:(6):597–604. https://doi.org/10.1086/670626
    [Google Scholar]
  11. Kasatpibal N, Nørgaard M, Sørensen HT, Schønheyder HC, Jamulitrat S, Chongsuvivatwong V. Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand. BMC Infect Dis. 2006; 6:111. doi: 10.1186/1471-2334-6-111.
    [Google Scholar]
  12. 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:(1):31–5. https://doi.org/10.5001/omj.2017.06
    [Google Scholar]
  13. Noorit P, Siribumrungwong B, Thakkinstian A. Clinical prediction score for superficial surgical site infection after appendectomy in adults with complicated appendicitis. World J Emerg Surg. 2018; 13:23. https://doi.org/10.1186/s13017-018-0186-1
    [Google Scholar]
  14. Giesen LJ, van den Boom AL, van Rossem CC, den Hoed PT, Wijnhoven BP. Retrospective multicenter study on risk factors for surgical site infections after appendectomy for acute appendicitis. Dig Surg. 2017; 34:(2):103–7. https://doi.org/10.1159/000447647
    [Google Scholar]
  15. Sohn M, Hoffmann M, Hochrein A, Buhr HJ, Lehmann KS. Laparoscopic appendectomy is safe: influence of appendectomy technique on surgical-site infections and intra-abdominal abscesses. Surg Laparosc Endosc Percutan Tech. 2015; 25:(3):e90–4. https://doi.org/10.1097/SLE.0000000000000115
    [Google Scholar]
  16. 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):1384–93. https://doi.org/10.1007/s00464-014-3809-y
    [Google Scholar]
  17. Garcell HG, Arias AV, Sandoval CP, Valle Gamboa ME, Sado AB, Alfonso Serrano RN. Impact of a focused antimicrobial stewardship program in adherence to antibiotic prophylaxis and antimicrobial consumption in appendectomies. J Infect Public Health. 2017; 10:(4):415–20. https://doi.org/10.1016/j.jiph.2016.06.006
    [Google Scholar]
  18. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009; 37:(10):783–805. https://doi.org/10.1016/j.ajic.2009.10.001
    [Google Scholar]
  19. National Healthcare Safety Network (NHSN). CDC/NHSN surveillance definitions for specific types of infections. Patient Safety Component Manual. 2023. [cited 2023 January 31]. Available from: https://www.cdc.gov/nhsn/psc/ssi/
    [Google Scholar]
  20. Jurt J, Floquet L, Hübner M, Moulin E, Senn L, Demartines N, Grass F. Implementing a surgical site infection prevention bundle for emergency appendectomy: worth the effort or waste of time?. Surgery. 2022; 172:(1):11–5. https://doi.org/10.1016/j.surg.2022.01.027
    [Google Scholar]
  21. Balogun OS, Osinowo A, Afolayan M, Olajide T, Lawal A, Adesanya A. Acute perforated appendicitis in adults: management and complications in Lagos, Nigeria. Ann Afr Med. 2019; 18:(1):36–41. https://doi.org/10.4103/aam.aam_11_18
    [Google Scholar]
  22. Poprom N, Wilasrusmee C, Attia J, McEvoy M, Thakkinstian A, Rattanasiri S. Comparison of postoperative complications between open and laparoscopic appendectomy: an umbrella review of systematic reviews and meta-analyses. J Trauma Acute Care Surg. 2020; 89:(4):813–20. https://doi.org/10.1097/TA.0000000000002878
    [Google Scholar]
  23. Calderwood MS, Anderson DJ, Bratzler DW, Dellinger EP, Garcia-Houchins S, Maragakis LL, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol. 2023; 44:(5):695–720. https://doi.org/10.1017/ice.2023.67
    [Google Scholar]
  24. Puri M, Nain S, Gautam A, Chaudhary V, Jaiswal N, Gs T, et al. Rational use of antibiotics for major elective gynaecological and obstetrical surgical procedures: quality improvement journey from a tertiary care public facility. BMJ Open Qual. 2022; 11:(Suppl 1):e001438. https://doi.org/10.1136/bmjoq-2021-001438
    [Google Scholar]
  25. Kashtan M, Dawson M, Anandalwar S, Hills-Dunlap J, Graham DA, Rangel S. Implementation of a Plan-Do-Study-Act framework to reduce unindicated surgical antimicrobial prophylaxis. J Pediatr Surg. 2020; 55:(1):86–9. https://doi.org/10.1016/j.jpedsurg.2019.09.059
    [Google Scholar]
  26. Sánchez-Santana T, Del-Moral-Luque JA, Gil-Yonte P, Bañuelos-Andrío L, Durán-Poveda M, Rodríguez-Caravaca G. Efecto de la adecuación a protocolo de la profilaxis antibiótica en la incidencia de infección quirúrgica en apendicectomías. Estudio de cohortes prospectivo. Cir Cir. 2017; 85:(3):208-213. Spanish. doi: 10.1016/j.circir.2016.09.004.
    [Google Scholar]
  27. Mueck KM, Putnam LR, Anderson KT, Lally KP, Tsao K, Kao LS. Does compliance with antibiotic prophylaxis in pediatric simple appendicitis matter?. J Surg Res. 2017; 216:1-8. doi: 10.1016/j.jss.2017.04.002.
    [Google Scholar]
  28. Durán-Poveda M, Gil-Yonte P, Rodríguez-Villar D, García-Cruces J, Rodríguez-Caravaca G, Román-Montero JS. Adequacy of antibiotic prophylaxis protocol in appendectomies in children. Cir Cir. 2019; 87:(4):410-415. English. doi: 10.24875/CIRU.19000663.
    [Google Scholar]
  29. Alanzi A, Adeel S, Hakmi S, AlDerazi A. Adherence to the Antibiotic Prophylaxis Guidelines for Appendectomy in Bahrain: An Observational Study. Cureus. 2023; 15:(3):e36975. doi: 10.7759/cureus.36975.
    [Google Scholar]
  30. Litz CN, Asuncion JB, Danielson PD, Chandler NM. Timing of antimicrobial prophylaxis and infectious complications in pediatric patients undergoing appendectomy. J Pediatr Surg. 2018; 53:(3):449-451. doi: 10.1016/j.jpedsurg.2017.05.005.
    [Google Scholar]
  31. Berrondo C, Carone M, Katz C, Kenny A. Adherence to Perioperative Antibiotic Prophylaxis Recommendations and Its Impact on Postoperative Surgical Site Infections. Cureus. 2022; 14:(6):e25859. doi: 10.7759/cureus.25859.
    [Google Scholar]
  32. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020; 15:(1):27. doi: 10.1186/s13017-020-00306-3.
    [Google Scholar]
  33. Norman G, Atkinson RA, Smith TA, Rowlands C, Rithalia AD, Crosbie EJ, et al. Intracavity lavage and wound irrigation for prevention of surgical site infection. Cochrane Database Syst Rev. 2017; 10:(10):CD012234. https://doi.org/10.1002/14651858.CD012234.pub2
    [Google Scholar]
  34. Yen YT, Loh EW, Tam KW. Effect and safety of peritoneal lavage for appendectomy: A meta-analysis. Surgeon. 2021; 19:(6):e430–9. https://doi.org/10.1016/j.surge.2021.01.001
    [Google Scholar]
  35. Zhou Q, Meng W, Ren Y, Li Q, Boermeester MA, Nthumba PM, et al. Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis. World J Emerg Surg. 2023; 18:(1):24. https://doi.org/10.1186/s13017-023-00496-6
    [Google Scholar]
/content/journals/10.5339/jemtac.2024.18
Loading
/content/journals/10.5339/jemtac.2024.18
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): appendectomyQatarrisk factors and surgical site infection
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error