Hospital Practices and Research

Risk Factors for Surgical Site Infection After Appendectomy for Acute Appendicitis; Results of a Cross-Sectional Study Carried out at a Community Hospital in Qatar (2013-2016)

Document Type : Original Article

Authors

Humberto Guanche Garcell 1
Ariadna Villanueva Arias 1
Cristobal A. Pancorbo Sandoval 2
Adam Bode Sado 2
Ramón Nonato Alfonso Serrano 2
Francisco Gutierrez García 3

1 Infection Control Department, The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar

2 Surgical Department, The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar

3 Hospital Epidemiology Department, Hospital Joaquín Albarrán, La Habana, Cuba

10.15171/hpr.2019.08
Abstract
Background: Identifying risk factors for surgical site infection (SSI) after appendectomies could be useful in focusing prevention programs.
Objective: The current study aimed to identify the risk factors associated with SSI in a cohort of patients from a single center in Western Qatar.
Methods: This cross-sectional study was carried out at The Cuban Hospital (Dukhan, Qatar) on patients who had undergone an appendectomy from January 2013 through September 2016. Data extracted from the patient files included demographics, comorbidities and toxic habits, surgery type, procedure duration, wound type, appendicitis-type, American Anesthesiology Score, body mass index, selected laboratory tests, and compliance with antibiotic prophylaxis.
Results: The study variables, type of surgery performed, procedure duration, wound and appendicitis type, serum albumin, and timing of antibiotic prophylaxis, were found to be related to the occurrence of SSI in univariate analysis (P = 0.000). Logistic regression showed that open appendectomies (odds ratio [OR] = 22.90, 95% CI; 8.04-65.21), low serum albumin (OR = 0.92, 95% CI; 0.85-0.99), and improper timing of antibiotic prophylaxis (OR = 44.92, 95% CI; 3.39-594.91) were independently associated with the occurrence of SSI.
Conclusion: Cases of complex appendicitis, open procedure, low serum albumin level, and improper timing of antibiotic prophylaxis constituted the risk factors for SSI in the setting of this study. The infection control program should focus on improving the quality of antibiotic prophylaxis and closely monitoring patients who undergo open surgical procedures.

Keywords

Appendicitis
Appendectomy
Surgical Site Infection
Risk Factors
Qatar
  1. Garcell HG, Arias AV, Sandoval CA, et al. Incidence and Etiology of Surgical Site Infections in Appendectomies: A 3-Year Prospective Study. Oman Med J. 2017;32(1):31-35. doi:10.5001/omj.2017.06.
  2. 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(2):97-132; quiz 133-134; discussion 196. doi:10.1016/S0196-6553(99)70088-X.
  3. Ming PC, Yan TY, Tat LH. Risk factors of postoperative infections in adults with complicated appendicitis. Surg Laparosc Endosc Percutan Tech. 2009;19(3):244-248. doi:10.1097/SLE.0b013e3181a4cda2.
  4. Martin ET, Kaye KS, Knott C, et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. 2016;37(1):88-99. doi:10.1017/ice.2015.249.
  5. Cho M, Kang J, Kim IK, Lee KY, Sohn SK. Underweight body mass index as a predictive factor for surgical site infections after laparoscopic appendectomy. Yonsei Med J. 2014;55(6):1611- 1616. doi:10.3349/ymj.2014.55.6.1611.
  6. Giesen LJ, van den Boom AL, van Rossem CC, den Hoed PT, Wijnhoven BP. Retrospective Multicenter Study on Risk Factors for Surgical Site Infections after Appendectomy for Acute Appendicitis. Dig Surg. 2017;34(2):103-107. doi:10.1159/000447647.
  7. Xiao Y, Shi G, Zhang J, et al. Surgical site infection after laparoscopic and open appendectomy: a multicenter large consecutive cohort study. Surg Endosc. 2015;29(6):1384-1393. doi:10.1007/s00464-014-3809-y.
  8. Biondi A, Di Stefano C, Ferrara F, Bellia A, Vacante M, Piazza L. Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emerg Surg. 2016;11(1):44. doi:10.1186/s13017-016-0102-5.
  9. van Rossem CC, Bolmers MD, Schreinemacher MH, van Geloven AA, Bemelman WA. Prospective nationwide outcome audit of surgery for suspected acute appendicitis. Br J Surg. 2016;103(1):144-151. doi:10.1002/bjs.9964.
  10. Edwards JR, Peterson KD, Mu Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37(10):783- 805. doi:10.1016/j.ajic.2009.10.001.
  11. Rosenthal VD, Richtmann R, Singh S, 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(6):597- 604. doi:10.1086/670626.
  12. Cho J, Park I, Lee D, Sung K, Baek J, Lee J. Antimicrobial treatment after laparoscopic appendectomy for preventing a post-operative intraabdominal abscess: a prospective cohort study of 1817 patients. Int J Surg. 2016;27:142-146. doi:10.1016/j.ijsu.2016.01.069.
  13. Brenner P, Nercelles P. Prevention of Surgical Site Infection. In: IFIC Basic Concepts of Infection Control. 2nd ed. International Federation of Infection Control; 2011.
  14. Lubega A, Joel B, Justina Lucy N. Incidence and Etiology of Surgical Site Infections among Emergency Postoperative Patients in Mbarara Regional Referral Hospital, South Western Uganda. Surg Res Pract. 2017;2017:6365172. doi:10.1155/2017/6365172.
  15. Yuwen P, Chen W, Lv H, et al. Albumin and surgical site infection risk in orthopaedics: a meta-analysis. BMC Surg. 2017;17(1):7. doi:10.1186/s12893-016-0186-6.
  16. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784- 791. doi:10.1001/jamasurg.2017.0904.
  17. Wu WT, Tai FC, Wang PC, Tsai ML. Surgical site infection and timing of prophylactic antibiotics for appendectomy. Surg Infect (Larchmt). 2014;15(6):781-785. doi:10.1089/sur.2013.167.
  18. Sánchez-Santana T, Del-Moral-Luque JA, Gil-Yonte P, Banuelos- Andrio L, Duran-Poveda M, Rodriguez-Caravaca G. [Effect of compliance with an antibiotic prophylaxis protocol in surgical site infections in appendectomies. Prospective cohort study]. Cir Cir. 2017;85(3):208-213. doi:10.1016/j.circir.2016.09.004.

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