RISK STRATIFICATION FOR SURGICAL SITE INFECTIONS IN EMERGENCY APPENDECTOMIES
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Abstract
Surgical site infections (SSIs) are a significant cause of morbidity following appendectomy, particularly in the emergency setting. This study aimed to identify and stratify risk factors for SSIs in patients undergoing emergency appendectomy. A retrospective cohort study was conducted on 500 consecutive patients who underwent emergency appendectomy at our institution between January 2020 and December 2021. Data collected included patient demographics, comorbidities (e.g., diabetes, obesity), intraoperative findings (e.g., gangrenous or perforated appendix), duration of surgery, and antibiotic prophylaxis. The primary outcome was the development of a superficial, deep, or organ-space SSI within 30 days of surgery. Univariate analysis revealed several factors significantly associated with an increased risk of SSI, including a perforated appendix (p<0.001), prolonged operative time (>90 minutes, p=0.005), and a high body mass index (BMI) (>30 kg/m2, p=0.012). Multivariable logistic regression identified a perforated appendix as the strongest independent predictor of SSI (adjusted odds ratio [OR] 4.5, 95% confidence interval [CI] 2.1-9.8). Based on these findings, a risk stratification model was developed, categorizing patients into low-, intermediate-, and high-risk groups. Patients with a perforated appendix were classified as high-risk, those with an inflamed but non-perforated appendix and a BMI >30 or prolonged surgery as intermediate-risk, and all others as low-risk. This stratification model provides a valuable tool for identifying patients at high risk of developing SSIs. By proactively identifying these patients, surgeons can implement targeted interventions, such as prolonged postoperative antibiotic therapy or enhanced wound care protocols, to potentially reduce the incidence of this common complication. Future prospective studies are warranted to validate this risk stratification model and evaluate the effectiveness of these targeted interventions.
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Dr. Vikash Kumar
Assistant Professor, Department of General Surgery, Meenakshi Medical College Hospital & Research Institute.