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Wound management in perforated appendicitis.

T P Lemieur1, J L Rodriguez, D M Jacobs

  • 1Department of Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, USA.

The American Surgeon
|May 7, 1999
PubMed
Summary
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Primary wound closure after appendectomy is safe for non-perforated appendicitis. However, for perforated appendicitis, leaving the surgical wound open is recommended to reduce surgical wound infections (SWIs) and readmission rates.

Area of Science:

  • Surgery
  • Infectious Diseases

Background:

  • Traditionally, open wound management was standard for perforated appendicitis.
  • Recent trends advocate for primary wound closure to decrease costs and patient morbidity.

Purpose of the Study:

  • To evaluate the safety and outcomes of primary wound closure versus open wound management in patients undergoing appendectomy.
  • To identify risk factors associated with surgical wound infections (SWIs) following appendectomy for perforated appendicitis.

Main Methods:

  • Retrospective review of hospital records for 319 adult patients who underwent appendectomy between 1993 and 1996.
  • Data collected included patient demographics, length of stay (LOS), operative time, white blood cell count, antibiotic use, and perforation status (clinical or microscopic).
  • Comparison of SWI rates, readmission rates, and LOS between primary closure and open management groups based on perforation status.

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Main Results:

  • Patients with acute appendicitis and perforation undergoing primary wound closure had a 4-fold higher readmission rate, a 5-fold increase in SWI, and double the LOS compared to those without perforation.
  • No significant difference in LOS was observed for grossly perforated appendicitis treated with open versus primary closure.
  • No SWIs occurred in patients with microscopic perforation who underwent primary wound closure.

Conclusions:

  • Primary wound closure is a safe approach for appendicitis cases without clinical perforation.
  • For patients with clinical appendiceal perforation, leaving the surgical wound open is advisable to minimize complications such as SWIs and reduce readmissions.