Comparison of surgical site infection between the primary and delayed primary closure in patients with complicated appendicitis; a Randomized clinical trial
School of Medicine Students' Journal,
Vol. 2 No. 1 (2020),
22 April 2020
Background and aims: Acute appendicitis is one of the common surgical emergencies. Surgical wounds after complicated (perforated/gangrenous) usually are managed with delayed primary closure (DPC) rather than primary closure (PC); however, choosing of the best closure method is controversial. The aim of this study was to compare the difference in the rate of surgical wound infection between the primary closure and delayed primary closure after complicated appendicitis.
Materials and methods: This randomized clinical trial was conducted on patients who referred to the emergency department of Loghman Hakim hospital with the chief complaint of acute appendicitis from February 2014 to Feb 2018. The inclusion criteria were perforated and gangrenous appendicitis. The patients were divided randomly into to equal group based on the flipping coin. Demographic features, the rate of surgical site infection, hospitalization time in the primary closure and delayed primary closure groups compared with each other.
Results: Sixty-nine patients include in the final analysis. Thirty-five patients were in the primary closure group and 34 patients were in the delayed primary closure group. Surgical site infection was observed in 6 patients, including 4 patients in the primary closure group and 2 patients in the delayed primary closure group (P value = 0.66). In addition, the hospitalization period was 3.5 ± 0.42 and 5.30 ± 0.21 in the primary closure and in the delayed primary closure respectively (P value = 0.001).
Conclusion: There are no differences between the primary closure and delayed primary closure in the context of surgical site infection. However, the hospitalization time will be longer in the delayed primary closure of the complicated appendicitis wound.
- Surgical Site Infection
- Complicated Appendicitis
- Wound Closure
How to Cite
Rotermann M. Infection after cholecystectomy, hysterectomy or appendectomy. Health reports. 2004;15(4):11-23.
Jroundi I, Khoudri I, Azzouzi A, Zeggwagh AA, Benbrahim NF, Hassouni F, et al. Prevalence of hospital-acquired infection in a Moroccan university hospital. American journal of infection control. 2007;35(6):412-6.
Isik O, Kaya E, Dundar H, Sarkut P. Surgical site infection: re-assessment of the risk factors. Chirurgia (Bucur). 2015;110(5):457-61.
Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA surgery. 2017;152(8):784-91.
Cho M, Kang J, Kim I-k, Lee KY, Sohn S-K. Underweight body mass index as a predictive factor for surgical site infections after laparoscopic appendectomy. Yonsei medical journal. 2014;55(6):1611-6.
Weigelt JA, Lipsky BA, Tabak YP, Derby KG, Kim M, Gupta V. Surgical site infections: causative pathogens and associated outcomes. American journal of infection control. 2010;38(2):112-20.
Lewis SS, Moehring RW, Chen LF, Sexton DJ, Anderson DJ. Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infection Control & Hospital Epidemiology. 2013;34(11):1229-30.
Kusachi S, Kashimura N, Konishi T, Shimizu J, Kusunoki M, Oka M, et al. Length of stay and cost for surgical site infection after abdominal and cardiac surgery in Japanese hospitals: multi-center surveillance. Surgical infections. 2012;13(4):257-65.
Urban JA. Cost analysis of surgical site infections. Surgical infections. 2006;7 Suppl 1:S19-22.
Fukuda H, Morikane K, Kuroki M, Kawai S, Hayashi K, Ieiri Y, et al. Impact of surgical site infections after open and laparoscopic colon and rectal surgeries on postoperative resource consumption. Infection. 2012;40(6):649-59.
Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology. 1990;132(5):910-25.
Chiang R-A, Chen S-L, Tsai Y-C. Delayed primary closure versus primary closure for wound management in perforated appendicitis: A prospective randomized controlled trial. Journal of the Chinese Medical Association. 2012;75(4):156-9.
Chiang R-A, Chen S-L, Tsai Y-C, Bair M-J. Comparison of primary wound closure versus open wound management in perforated appendicitis. Journal of the Formosan Medical Association. 2006;105(10):791-5.
Hepburn H. Delayed primary suture of wounds. British Medical Journal. 1919;1(3033):181.
Duttaroy DD, Jitendra J, Duttaroy B, Bansal U, Dhameja P, Patel G, et al. Management strategy for dirty abdominal incisions: primary or delayed primary closure? A randomized trial. Surgical infections. 2009;10(2):129-36.
Stone HH, Hester TR. Topical antibiotic and delayed primary closure in the management of contaminated surgical incisions. Journal of Surgical Research. 1972;12(2):70-6.
Pettigrew RA. Delayed primary wound closure in gangrenous and perforated appendicitis. British Journal of Surgery. 1981;68(9):635-8.
Lewis FR, Holcroft JW, Boey J, Dunphy JE. Appendicitis: a critical review of diagnosis and treatment in 1,000 cases. Archives of Surgery. 1975;110(5):677-84.
Ahmad M, Ali K, Latif H, Naz S, Said K. Comparison of primary wound closure with delayed primary closure in perforated appendicitis. Journal of Ayub Medical College Abbottabad. 2014;26(2):153-7.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. American journal of infection control. 2008;36(5):309-32.
Cooperman M. Complications of appendectomy. The Surgical clinics of North America. 1983;63(6):1233-47.
Raahave D, Friis-Møller A, Bjerre-Jepsen K, Thiis-Knudsen J, Rasmussen LB. The infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis. Archives of Surgery. 1986;121(8):924-9.
Meissner K, Meiser G. Primary open wound management after emergency laparotomies for conditions associated with bacterial contamination: reappraisal of a historical tradition. The American journal of surgery. 1984;148(5):613-7.
Serour F, Efrati Y, Klin B, Barr J, Gorenstein A, Vinograd I. Subcuticular skin closure as a standard approach to emergency appendectomy in children: prospective clinical trial. World journal of surgery. 1996;20(1):38-42.
Rucinski J, Fabian T, Panagopoulos G, Schein M, Wise L. Gangrenous and perforated appendicitis: a meta-analytic study of 2532 patients indicates that the incision should be closed primarily. Surgery. 2000;127(2):136-41.
Lemieur TP, Rodriguez JL, Jacobs DM, Bennett ME, West MA. Wound management in perforated appendicitis. The American surgeon. 1999;65(5):439-43.
Yellin A, Berne T, Heseltine P, Appleman M, Gill M, Chin A, et al. Prospective randomized study of two different doses of clindamycin admixed with gentamicin in the management of perforated appendicitis. The American surgeon. 1993;59(4):248-55.
Tsang TM, Tam PK, Saing H. Delayed primary wound closure using skin tapes for advanced appendicitis in children: a prospective, controlled study. Archives of Surgery. 1992;127(4):451-3.
Siribumrungwong B, Chantip A, Noorit P, Wilasrusmee C, Ungpinitpong W, Chotiya P, et al. Comparison of Superficial Surgical Site Infection Between Delayed Primary Versus Primary Wound Closure in Complicated Appendicitis: A Randomized Controlled Trial. Ann Surg. 2018;267(4):631-7.
Henry MC, Moss RL. Primary versus delayed wound closure in complicated appendicitis: an international systematic review and meta-analysis. Pediatric surgery international. 2005;21(8):625-30.
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