Effect of Plastic Bag Extraction in Minimally Invasive Appendectomy

Abstract

Background Evidence regarding the effects of plastic bag use for appendix removal during minimally invasive appendectomy remains scarce and conflicting. Objective This study aimed to analyze the effects of plastic bag use during minimally invasive appendectomy on preoperative infection risk, morbidity and mortality. Design This retrospective analysis of the prospective National Surgical Quality Improvement Program (NSQIP) cohort program. Setting This study included data from the NSQIP database between the years of 2016 and 2019. Patient Adult patients undergoing minimally invasive (laparoscopic or robotic) without unplanned conversion to open surgery. Intervention Use of plastic bag for specimen removal during appendectomy. Main Outcome Measures Risk ratios for the incidence of superficial surgical site infection, intra-abdominal abscess, overall medical morbidity, and overall mortality. Results There were 43 783 cases of minimally invasive appendectomy in the NSQIP database between the years of 2016 and 2019. Among those who reported information regarding use of plastic bag, 28 589 (91.87%) reported use of plastic bag for specimen removal. Use of plastic bag was associated with a significant decrease in superficial surgical site infection (RR .39 (95% CI: .31-.49), P < .001), and in the risk of postoperative intra-abdominal abscess (RR: 0.66 (.57-.77), P < .001)). We also observed a robust reduction in overall medical-related morbidity and overall mortality, even after adjusting for multiple confounders. Limitations Observational nature of the study cannot exclude residual bias. Also, there was a significant rate of missing values for plastic bag use, which may bias results. Conclusions In this global prospective cohort using NSQIP database, use of plastic bag for appendix removal during minimally invasive appendectomy was associated with a significant improvement in surgical related outcomes and reduction in morbidity and overall mortality.

Bowel preparation for elective colectomy in Crohn's disease: results from a global cohort study using the NSQIP database

“…The concept of all-cause morbidity included any episode of return to the operating room, myocardial infarction, deep vein thrombosis, pneumonia, acute renal failure, cardiac arrest, urinary tract infection, wound disruption, pulmonary embolism, progression of renal failure and postoperative sepsis. This all-cause morbidity cohort has already been validated in previous studies [11,12] using data from the NSQIP and was included in our statistical analysis programme.…”