Cost analysis of utilising wound edge protector in open appendicectomy to prevent surgical site infection

Abstract

Background The rate of surgical site infection (SSI) differ with variable nature with appendicitis with a global incidence of up to 11%. Several randomised trials describe a significant reduction in incisional SSI using wound edge protectors (WEP), mainly in elective procedures. This study was designed to analyse WEP use in emergency open appendicectomy. Method This randomised controlled trial enrolled 200 patients who underwent emergency open appendicectomy. Permuted block randomisation was used to assign subjects to either mechanical retraction or double ring WEP. The primary endpoints were SSI rates and cost analysis between the methods. Results The incidence of SSI was similar, n = 7 (7.4%) in the control group and n = 8 (8.4%) in the WEP group, and demonstrates no statistically significant difference (p > 0.05). Cost analysis showed a statistically significant (p < 0.001) higher total cost in the WEP group, MYR 456.00 (414.75, 520.00) as compared to the control group, MYR 296.00 (296.00, 300.00). However, the median cost of managing patients complicated with SSI was significantly lower at MYR 750.50 (558.75, 946.50) in the WEP group when compared to the control group MYR 1453.00 (1119.00, 2592.00) (p = 0.008). Conclusion The use of WEP does not reduce the incisional SSI rate, and it is not cost-effective for application in all open appendicectomies. However, when faced with incisional SSI, the use of WEP had a significantly lower cost in incisional SSI management. Selective WEP use is economical in clinically suspected perforated appendicitis when laparoscopic appendicectomy approach is unsuitable.

Effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery: A meta‐analysis

“…A total of 1365 relevant studies were screened, of which 28 studies between 1969 and 2021, met the inclusion criteria and were involved in the meta‐analysis 15‐42 . Data obtained from these studies were shown in Table 2.…”

“…A total of 1365 relevant studies were screened, of which 28 studies between 1969 and 2021, met the inclusion criteria and were involved in the meta‐analysis. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 Data obtained from these studies were shown in Table 2 . The selected studies included 6026 subjects with lower gastrointestinal surgery at the baseline of the studies; 3090 of them were using the wound protector, and 2936 were using no wound protector.…”

“…The current meta‐analysis involved 6026 subjects with lower gastrointestinal surgery at the baseline of the studies; 3090 of them were using the wound protector, and 2936 were using no wound protector 15‐42 . The surgical site wound infection was significantly lower with single‐ring wound protectors, and dual‐ring wound protectors in subjects with lower gastrointestinal surgery compared with no wound protector.…”

The clinical effectiveness of wound edge protectors in reducing surgical site infection after abdominal surgery: meta-analysis

“…2 ). Six included trials were considered as high quality 15 , 17 , 19 , 23 , 38 , 40 , 13 were considered moderate quality 12 , 16 , 18 , 20–22 , 24–28 , 31 , 41 , and 2 were considered low quality 29 , 30 , 39 ( Fig. 2 ).…”

“…Previous studies revealed that dual-loop devices are more effective in reducing SSI incidence; however, there are limited available data on dual-ring devices, and so, sufficient robust high-quality testing is warranted 33 , 34 . This article includes newly published RCTs of high quality that employed dual-ring devices 38 , 40 , 41 . It has been suggested that double-ring devices might prevent SSI more effectively than single-ring devices 37 .…”