J Korean Surg Soc.  2012 Jan;82(1):35-39. 10.4174/jkss.2012.82.1.35.

Comparison of surgical-site infection between open and laparoscopic appendectomy

• Suh YJ
• Jeong SY
• Park KJ
• Park JG
• Kang SB
• Kim DW
• Oh HK
• Shin R
• Kim JS

• KMID: 1437753
• DOI: http://doi.org/10.4174/jkss.2012.82.1.35

Abstract

PURPOSE
An inflamed appendix can be removed either openly (open appendectomy [OA]) or laparoscopically (laparoscopic appendectomy [LA]). Surgical-site infection (SSI) is a representative healthcare-associated infection and can impose serious economic burdens on patients as well as affect morbidity and mortality rates. The aim of this study was to compare LA with OA in terms of SSI.
METHODS
The medical records of 749 patients (420 males; mean age, 33 years) who underwent appendectomy (OA, 431; LA, 318) between September 1, 2008 and April 29, 2010 were retrospectively reviewed for demographic and pathologic characteristics, recovery of bowel movement, length of hospital stay, and postoperative complications.
RESULTS
The frequency of purulent/gangrenous or perforated appendicitis was not significantly different between LA and OA groups (83% [263/318 cases] vs. 83% [359/431 cases], P = 0.183). The time to first flatus after surgery was not significantly different between the two groups (1.38 +/- 1.07 days for LA, 1.33 +/- 0.90 days for OA, P = 0.444), but the length of hospital stay was significantly shorter in LA group than in OA group (3.37 +/- 0.12 days vs. 3.83 +/- 0.12 days, P = 0.006). The frequency of overall SSI was not significantly different between the two groups (2.8% for LA, 4.6% for OA, P = 0.204), but that of superficial incisional SSI was significantly lower in LA group (0.6% vs. 3.9%, P = 0.016).
CONCLUSION
The results of this study suggest that LA may lead to a shorter length of hospital stay and may have a lower risk of superficial incisional SSI than OA.

Keyword

Laparoscopic; Appendectomy; Surgical-site infection

MeSH Terms

Appendectomy
Appendicitis
Appendix
Flatulence
Humans
Length of Stay
Medical Records
Retrospective Studies

Reference

1. McBurney C. IV. The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg. 1894. 20:38–43.

2. Semm K. Endoscopic appendectomy. Endoscopy. 1983. 15:59–64.

3. Moberg AC, Berndsen F, Palmquist I, Petersson U, Resch T, Montgomery A. Randomized clinical trial of laparoscopic versus open appendicectomy for confirmed appendicitis. Br J Surg. 2005. 92:298–304.

4. Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2004. (4):CD001546.

5. Bennett J, Boddy A, Rhodes M. Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutan Tech. 2007. 17:245–255.

6. Aziz O, Athanasiou T, Tekkis PP, Purkayastha S, Haddow J, Malinovski V, et al. Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg. 2006. 243:17–27.

7. Kim CB, Kim MS, Hong JH, Lee HY, Yu SH. Is laparoscopic appendectomy useful for the treatment of acute appendicitis in Korea? A meta-analysis. Yonsei Med J. 2004. 45:7–16.

8. Shalak F, Almulhim SI, Ghantous S, Yazbeck S. Laparoscopic appendectomy: burden or benefit? A single-center experience. J Laparoendosc Adv Surg Tech A. 2009. 19:427–429.

9. Hart R, Rajgopal C, Plewes A, Sweeney J, Davies W, Gray D, et al. Laparoscopic versus open appendectomy: a prospective randomized trial of 81 patients. Can J Surg. 1996. 39:457–462.

10. Minné L, Varner D, Burnell A, Ratzer E, Clark J, Haun W. Laparoscopic vs open appendectomy. Prospective randomized study of outcomes. Arch Surg. 1997. 132:708–711.

11. Ingraham AM, Cohen ME, Bilimoria KY, Pritts TA, Ko CY, Esposito TJ. Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery. 2010. 148:625–635.

12. Tuggle KR, Ortega G, Bolorunduro OB, Oyetunji TA, Alexander R, Turner PL, et al. Laparoscopic versus open appendectomy in complicated appendicitis: a review of the NSQIP database. J Surg Res. 2010. 163:225–228.

13. Varela JE, Wilson SE, Nguyen NT. Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg Endosc. 2010. 24:270–276.

14. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999. 20:725–730.

15. Herwaldt LA, Cullen JJ, Scholz D, French P, Zimmerman MB, Pfaller MA, et al. A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections. Infect Control Hosp Epidemiol. 2006. 27:1291–1298.

16. Sahm M, Kube R, Schmidt S, Ritter C, Pross M, Lippert H. Current analysis of endoloops in appendiceal stump closure. Surg Endosc. 2011. 25:124–129.

17. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999. 27:97–132.

18. Khan MN, Fayyad T, Cecil TD, Moran BJ. Laparoscopic versus open appendectomy: the risk of postoperative infectious complications. JSLS. 2007. 11:363–367.

19. Cantürk Z, Cantürk NZ, Cetinarslan B, Utkan NZ, Tarkun I. Nosocomial infections and obesity in surgical patients. Obes Res. 2003. 11:769–775.

20. Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, et al. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg. 2004. 239:43–52.

21. Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: a metaanalysis. J Am Coll Surg. 1998. 186:545–553.

22. Markides G, Subar D, Riyad K. Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg. 2010. 34:2026–2040.

23. Wei HB, Huang JL, Zheng ZH, Wei B, Zheng F, Qiu WS, et al. Laparoscopic versus open appendectomy: a prospective randomized comparison. Surg Endosc. 2010. 24:266–269.

24. Varlet F, Tardieu D, Limonne B, Metafiot H, Chavrier Y. Laparoscopic versus open appendectomy in children--comparative study of 403 cases. Eur J Pediatr Surg. 1994. 4:333–337.

25. Moore DE, Speroff T, Grogan E, Poulose B, Holzman MD. Cost perspectives of laparoscopic and open appendectomy. Surg Endosc. 2005. 19:374–378.