Intra-abdominal 0.05% Chlorhexidine Gluconate Lavage in Perforated Appendicitis

In August 2021, pediatric surgeons at our institution began using 0.05% chlorhexidine gluconate (CHG) solution in sterile water for intraoperative lavage during laparoscopic appendectomies. The goal of this study is to determine the efficacy of intraoperative lavage with 0.05% CHG in preventing surgical site infection (SSI) after appendectomy for pediatric perforated appendicitis.

The Electronic Medical Record was queried to identify patients aged <18 y who underwent laparoscopic appendectomy for perforated appendicitis between January 2018 and February 2025 at our institution. Demographics, preoperative laboratory values, and postoperative complications were compared between patients who did and did not receive 0.05% CHG lavage. Postoperative outcomes, including the rates of deep/organ-space SSI requiring a drainage procedure, inpatient readmission, return to operating room, and emergency department revisits, were compared between treatment and control groups with Firth logistic regression and inverse probability of treatment weighting.

A total of 858 cases of laparoscopic appendectomy for perforated appendicitis were identified; 0.05% CHG lavage was used in 197 (23.0%). Postoperative drainage rate with and without 0.05% CHG lavage was 5.1% and 8.5%, respectively. Using Firth logistic regression and after adjustment for demographic variables and preoperative laboratory values, intraoperative 0.05% CHG lavage did not significantly impact the rate of deep/organ-space SSI requiring drainage procedure (adjusted odds ratio [OR]: 0.58, 95% confidence interval [CI: 0.29, 1.14]), inpatient readmission (OR: 1.40, 95% CI [0.77, 2.56]), return to the operating room (OR: 1.14, 95% CI [0.40, 3.29]), or emergency department revisit (OR: 1.19, 95% CI [0.71, 1.97]). Sensitivity analysis using inverse probability of treatment weighting was consistent with the primary Firth logistic regression analyses.

A 0.05% CHG lavage during laparoscopic appendectomy for perforated appendicitis was associated with a low rate of deep/organ-space SSI requiring drainage (5%). However, it does not significantly alter postoperative outcomes. Prospective studies are needed to evaluate whether this solution lowers infectious complications.