Abstract
Purpose
Although surgical site infections (SSI) are a major postoperative complication of appendectomy, few studies have focused on the risk factors for SSI. In this study, we investigated the risk factors for SSI in patients who had undergone appendectomy.
Methods
Three hundred patients who had undergone open appendectomy were enrolled. The patients were divided into two groups based on the presence or absence of SSI. A statistical analysis was performed to assess the clinical features associated with SSI after appendectomy.
Results
A multivariate analysis using the results of univariate analyses revealed that the serum C-reactive protein (CRP) level (≤65/>65, mg/l), length of the operation (≤80/>80, min) and pathology (catarrhal, phlegmonous/gangrenous) were associated with SSI. Among these three clinical features, only the CRP level was found to predict the risk of SSI prior to appendectomy (odds ratio 3.797; 95 % confidence intervals 1.305–11.04; P = 0.014).
Conclusion
Preoperative elevation of the serum CRP level (>65 mg/l) is a valuable predictor of SSI in patients undergoing appendectomy.
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Abbreviations
- CRP:
-
C-reactive protein
- GPS:
-
Glasgow prognostic score
- IL-6:
-
Interleukin-6
- NLR:
-
Neutrophil to lymphocyte ratio
- ROC curve:
-
Receiver operating characteristic curve
- SSI:
-
Surgical site infection
- WBC:
-
White blood cell
References
Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333:530–4.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;1999(20):250–78.
Itatsu K, Sugawara G, Kaneoka Y, Kato T, Takeuchi E, Kanai M, et al. Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: focus on intraoperative meticulous wound management. Surg Today. 2014;44:1242–52.
Alp E, Elmali F, Ersoy S, Kucuk C, Doganay M. Incidence and risk factors of surgical site infection in general surgery in a developing country. Surg Today. 2014;44:685–9.
Araki T, Okita Y, Uchino M, Ikeuchi H, Sasaki I, Funayama Y, et al. Risk factors for surgical site infection in Japanese patients with ulcerative colitis: a multicenter prospective study. Surg Today. 2014;44:1072–8.
Krukowski ZH, Irwin ST, Denholm S, Matheson NA. Preventing wound infection after appendicectomy: a review. Br J Surg. 1988;75:1023–33.
Moyes LH, Leitch EF, McKee RF, Horgan PG, McMillan DC. Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer. Br J Cancer. 2009;100:1236–9.
Shiozaki A, Fujiwara H, Okamura H, Murayama Y, Komatsu S, Kuriu Y, et al. Risk factors for postoperative respiratory complications following esophageal cancer resection. Oncol Lett. 2012;3:907–12.
Fujii T, Tabe Y, Yajima R, Murayama Y, Komatsu S, Kuriu Y, Ikoma H, et al. Relationship between C-reactive protein levels and wound infections in elective colorectal surgery: C-reactive protein as a predictor for incisional SSI. Hepatogastroenterology. 2011;58:752–5.
Dutta S, Fullarton GM, Forshaw MJ, Horgan PG, McMillan DC. Persistent elevation of C-reactive protein following esophagogastric cancer resection as a predictor of postoperative surgical site infectious complications. World J Surg. 2011;35:1017–25.
Walsh SR, Cok EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91:181–4.
Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. Br J Cancer. 2004;90:1704–6.
Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dagg K, Scott HR. A prospective longitudinal study of performance status, an inflammation-based score (GPS) and survival in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2005;92:1834–6.
Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32–5.
Frazee RC, Roberts JW, Symmonds RE, Snyder SK, Hendricks JC, Smith RW, et al. A prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg. 1994;219:725–8.
Macarulla E, Vallet J, Abad JM, Hussein H, Fernández E, Nieto B. Laparoscopic versus open appendectomy: a prospective randomized trial. Surg Laparosc Endosc. 1997;7:335–9.
Kazemier G, de Zeeuw GR, Lange JF, Hop WC, Bonjer HJ. Laparoscopic vs. open appendectomy. A randomized clinical trial. Surg Endosc. 1997;11:336–40.
Andersson RE, Hugander A, Ravn H, Offenbartl K, Ghazi SH, Nyström PO, et al. Repeated clinical and laboratory examinations in patients with an equivocal diagnosis of appendicitis. World J Surg. 2000;24:479–85.
Chamisa I. A clinicopathological review of 324 appendices removed for acute appendicitis in Durban, South Africa: a retrospective analysis. Ann R Coll Surg Engl. 2009;91:688–92.
Teixeira PG, Sivrikoz E, Inaba K, Talving P, Lam L, Demetriades D. Appendectomy timing: waiting until the next morning increases the risk of surgical site infections. Ann Surg. 2012;256:538–43.
Giraudo G, Baracchi F, Pellegrino L. Dal Corso HM, Borghi F. Prompt or delayed appendectomy? Influence of timing of surgery for acute appendicitis. Surg Today. 2013;43:392–6.
Asfar S, Safar H, Khoursheed M, Dashti H, al-Bader A. Would measurement of C-reactive protein reduce the rate of negative exploration for acute appendicitis? J R Coll Surg Edinb. 2000;45:21–4.
Reddy RC, Chen GH, Tekchandani PK, Standiford TJ. Sepsis-induced immunosuppression: from bad to worse. Immunol Res. 2001;24:273–87.
Angele MK, Chaudry IH. Surgical trauma and immunosuppression: pathophysiology and potential immunomodulatory approaches. Langenbecks Arch Surg. 2005;390:333–41.
Ni Choileain N, Redmond HP. The immunological consequences of injury. Surgeon. 2006;4:23–31.
Lenz A, Franklin GA, Cheadle WG. Systemic inflammation after trauma. Injury. 2007;38:1336–45.
Lee P, Waxman K, Taylor B, Yim S. Use of wound-protection system and postoperative wound-infection rates in open appendectomy. Arch Surg. 2009;144:872–5.
Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendectomy. Cochrane Database Syst Rev. 2005;(3):CD001439. doi:10.1002/14651858.
Bennett-Guerrero E, Pappas TN, Koltun WA, Fleshman JW, Lin M, Garg J, et al. Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery. N Engl J Med. 2010;363:1038–49.
Wang ZX, Jiang CP, Cao Y, Ding YT. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg. 2013;100:465–73.
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Shimizu, T., Ishizuka, M. & Kubota, K. The preoperative serum C-reactive protein level is a useful predictor of surgical site infections in patients undergoing appendectomy. Surg Today 45, 1404–1410 (2015). https://doi.org/10.1007/s00595-014-1086-y
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DOI: https://doi.org/10.1007/s00595-014-1086-y