Retrospective Study for Risk Factors of Surgical Site Infection After Appendectomy in Pediatric Patients at Vajira Hospital
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Abstract
BACKGROUND: The most common complication of a surgical operation is surgical site infection (SSI). SSI is associated with an increased length of stay and healthcare cost. Appendectomy is the most common surgical operation and infections at the site of the surgery are the most frequently observed complications following an appendectomy. Although antibiotic prophylaxis would be used, the wound infection at the surgical incision could increase morbidity in the patients.
OBJECTIVE: This study sought to assess the risk factors associated with postoperative infections at the site of the surgery after an appendectomy in pediatric patients at Vajira Hospital, Bangkok, Thailand over a five-year period.
METHODS: A retrospective study of appendectomy patients aged from 0 to 15 years whose appendicitis treatment was performed from January 2017 to December 2021, at Vajira Hospital. The demographic data of the patients, diagnosis, operative findings, and disease-related factors were analyzed.
RESULTS: The sample comprised 335 pediatric patients. Fifteen patients (4.4%) developed an SSI. In the univariable analysis, the longer operative time >60 minutes and the BMI for age of a 95th percentile or greater was associated with SSI. After binary logistic regression analysis, the BMI for age of the 95th percentile or higher showed a significant risk of infection at the site of surgery (OR 4.58; 95%CI 1.13-18.54).
CONCLUSIONS: BMI for age of the 95th percentile or greater (obesity) was the risk factor for SSI after an appendectomy in pediatric patients.
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References
Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000; 215: 337–48.
Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, et al. Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials. Dig Surg 2011;28:210–21.
Paajanen H, Grönroos JM, Rautio T, Nordström P, Aarnio M, Rantanen T, et al. A prospective randomized controlled multicenter trial comparing antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis (APPAC trial). BMC Surg [Internet]. 2013 [cited 2023 Apr 8];13:3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3585698/pdf/1471-2482-13-3.pdf
Rosenthal VD, Richtmann R, Singh S, Apisarnthanarak A, Kübler A, Viet-Hung N, et al. Surgical site infections, International Nosocomial Infection Control Consortium (INICC) report, data summary of 30 countries, 2005-2010. Infect Control Hosp Epidemiol 2013;34:597–604.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection,1999. Centers for disease control and prevention (CDC) hospital infection control practices advisory committee. Am J Infect Control 1999;27:97-132.
Dindo D, Muller MK, Weber M. Obesity in general elective surgery. Lancet 2003;362(9383): 577-8.
Sullivan E, Gupta A, Cook CH. Cost and consequences of surgical site infections: a call to arms. Surg Infect 2017;18:451–4.
Collins GS, Reitsma JB, Altman DG, Moons KG. Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): the TRIPOD Statement. Br J Surg 2015;102: 148–58.
National Healthcare Safety Network (NHSN). Patient Safety Component Manual [Internet]. Atlanta: NHSN; 2023. Chapter 9, Surgical Site Infection Event (SSI). [cited 2023 Apr 8]. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf
Chung S. Body mass index and body composition scaling to height in children and adolescent. Ann Pediatr Endocrinol Metab 2015;20:125–9.
Delgado-Miguel C, Muñoz-Serrano AJ, Barrena Delfa S, Núñez Cerezo V, Velayos M, Estefanía K, et al. Influence of overweight and obesity on acute appendicitis in children. A cohort study. Cir Pediatr 2020;33:20-4.
Meijs AP, Koek MBG, Vos MC, Geerlings SE, Vogely HC, de Greeff SC, et al. The effect of body mass index on the risk of surgical site infection. Infect Control Hosp Epidemiol 2019; 40:991-6.
Thelwall S, Harrington P, Sheridan E, Lamagni T. Impact of obesity on the risk of wound infection following surgery: Results from a nationwide prospective multicentre cohort study in England. Clin Microbiol Infect [Internet]. 2015 [cited 2023 Apr 8]; 21(11):1008.e1-8. Available from: https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(15)00719-3/fulltext
Blackwood BP, Gause CD, Harris JC, Theodorou CM, Helenowski I, Lautz TB, et al. Overweight and obese pediatric patients have an increased risk of developing a surgical site infection. Surg Infect (Larchmt) 2017;18:491-7
Mahmood MM, Shahab A, Razzaq MA. Surgical site infection in open versus laparoscopic appendectomy. Pakistan journal of medical and health sciences 2016;10:1076-8.