Correlation of Surgical Site Infection (SSI) after appendicectomy with per-operative morphological appearance of appendix.

Abstract

Acute appendicitis is the most common cause of emergency abdominal surgery worldwide. Postoperatively, surgical site infection (SSI) occurs in 3% to 60% of appendicectomized patients, depending on pathological state of appendix. SSI is a devastating complication from biologic and economic point of view and has enormous impact on patient’s quality of life. Objectives: To determine the frequency of surgical site infection after appendicectomy in patients presenting as acute appendicitis and correlate it with per-operative morphological appearance of appendix. Study Design: Cross-sectional study. Setting: Department of General Surgery, Liaquat University of Medical and Health Sciences Jamshoro. Period: One year from March 2015 to February 2016. Material & Methods: This study was carried out on 200 patients. All male and female patients above age of 12 years with clinical diagnosis of acute appendicitis or localized peritonitis due to perforated appendix undergoing appendectomy by grid iron incision and whose skin closed primarily by interrupted silk 2/0 stitches were included in the study. Operative findings were recorded and inflammation of appendix was graded into four categories. Postoperatively patients were followed for period of 30 days to check the development of SSI. Results: Out of 200 patients, 42 suffered from SSI (21%). On the basis of per-operative morphological appearance of appendix, uncomplicated appendicitis was significantly high 135(67.5%) than complicated appendicitis 65(32.5%). SSI developed in 12(28.5%) cased of uncomplicated and 30(71.5%) cases of complicated appendicitis. Conclusion: It was not possible to establish a relationship between SSI and per-operative morphological appearance of appendix. Frequency of SSI reported here (21%) is comparable with literature. We recommended that avoiding delay in diagnosis, use of peri-operative antibiotics, sound surgical technique to avoid wound contamination and continuing surveillance is necessary to further reduce SSI rates after open appendicectomy.