Surgical wound classification for pediatric appendicitis remains poorly documented despite targeted interventions

Area of Science:

• Surgical Quality Improvement
• Infection Control
• Patient Safety

Background:

• Surgical wound class (SWC) is crucial for reporting surgical site infections (SSIs).
• Previous studies showed poor agreement (8%) between hospital-based and diagnosis-based SWC for appendicitis.
• This highlights a need for improved SWC accuracy in clinical practice.

Purpose of the Study:

• To assess if education and process interventions can improve hospital-based SWC reporting.
• To enhance the validity of SWC for SSI risk stratification in pediatric appendectomies.
• To determine the impact of interventions on SWC accuracy and consistency.

Main Methods:

• A pre- and post-intervention study included pediatric appendectomy patients (<18 years).
• Interventions involved educational workshops and integrating SWC into the surgical safety checklist.
• Data on 30-day postoperative SSIs were collected and analyzed using statistical tests.

Main Results:

• Weighted interrater agreement between hospital-based and diagnosis-based SWC improved from 50% to 81% (p<0.01).
• Weighted kappa increased from 0.16 to 0.29, indicating better agreement.
• Post-intervention, hospital-based dirty wounds were significantly linked to SSIs (p<0.01).

Conclusions:

• Simple educational and process interventions significantly improved SWC agreement for appendicitis.
• Post-intervention SSI risk stratification aligned better with expected disease severity.
• Despite improvements, persistent gaps in SWC knowledge and application require attention.