Surgical Site Infection in Patients Undergoing Laparoscopic Appendectomy: A Single Center Review.

Author(s):
Emily Stock; Jackson Baril; Luke McCutcheon ; James Glover; Catherine Statz; Victor R. Vakayil; Robert Bulander; James Harmon

Background:

The treatment of acute appendicitis is evolving with an interest in avoiding surgical complications. Current literature notes a range of surgical site infection (SSI) rate after laparoscopic appendectomy (LA), ranging from 2.3% to 5.8%. As a part of a quality improvement surveillance initiative, we report the rates of SSI following LA for uncomplicated acute appendicitis at a single tertiary center.

Hypothesis:

Laparoscopic appendectomy is associated with low postoperative infectious morbidity.

Methods:

We performed a single-center review of adult patients undergoing laparoscopic appendectomy from 2011 to 2017. National Healthcare Safety Network definitions were used to evaluate 30-day postsurgical site infections. We performed a univariate analysis of baseline characteristics and identified variables associated with an increased rate of SSI.

Results:

878 patients underwent LA with an overall SSI rate of 1.9% (N=17) including two SSIs from 13 LA cases converted to open appendectomy. Mean age of the patient population was 34.1 ± 14.8 years with a BMI of 26.3 ± 5.9. ASA score was ≥3 in 8.8% of patients, and 39% had a wound class ≥3. Chlorhexidine-gluconate operative scrub was used in 97.8% of patients without infection and 92.3% of patients with SSI. On univariate analysis of the 865 LAs not converted to open, those who developed SSI (N=15) tended to be male (N=12, P=0.03), older (43.0 ± 15.7 years, P=0.04), have higher wound classification score (Median=3, P=0.009), and longer operative times (81.9 min ± 33.5, P=0.003). A total of 47% (N=7) of LA SSIs had positive wound cultures, 33% of which were Escherichia coli (Figure1). There were no isolates of Staphylococcus aureus. Excluded from this analysis is one SSI among 24 patients who underwent open appendectomy in the reporting period.

Conclusions:

We report a low rate of SSIs (1.9%) among patients who had LAs. We note a significantly increased rate of SSIs among patients of the male sex, higher BMI, and longer operative times.