Risk Factors of Superficial Surgical Site Infection in Open Appendectomy

Abstract

Background and Objective: Surgical site infection (SSI) after open appendectomy (OA) is a common healthcare-associated infection. The most common form of SSI is superficial (SSSI) which is associated with substantial morbidity and mortality. The aim of the study is to assess factors contributing to SSSI in emergency OA. Methods: This is a retrospective cohort study on patients who had emergency OA at Shar teaching hospital in Sulaimani City, Iraq for 6 months; from March to September 2022. Wound assessment was done by Centers for Disease Control and Prevention SSI Criteria (only skin of surgery site be affected, symptoms of pain or tenderness and erythema, purulent drainage, or organisms be found in wound culture). Demographic information, medical history, and preoperative and postoperative variables were compared and collected. Findings: Of 320 participants, 51.6% were men and their mean age was 21±12.2. Total number of SSIs were 35 (10.9%). There were no differences between groups based on gender. Age, obesity, smoking, chronic illness, multiple intraoperative and preoperative factors were associated with SSI in the bivariable analysis. However, after adjusting for predictors, only use of subcuticular suturing techniques was associated with a significantly higher risk of SSI compared to simple interrupted suturing (p=0.004, OR=20.184, 95%CI [2.673-152.437]); and proper bathing within first 5 days after surgery had a significantly lower risk of SSI compared to others (p=0.025, OR=0.042, 95% CI [0.004-0.417]). No significant association was found between presence or timing of drain removal, postoperative length of stay, changing of dressing, antiseptics, or suture removal day. Conclusion: The results of the study showed a wide range of effective factors in superficial surgical site infection in patients undergoing open appendectomy.