Frequency of Incisional Surgical Site Infection in Patients Undergoing Open Surgical Technique Appendectomy in Complicated Appendicitis

Syeda Sunaina Shah; Yousaf Jan; Mohsin Ali; . Fazalullah

doi:10.54112/bcsrj.v6i5.2250

Authors

Syeda Sunaina Shah Department of Surgery, Hayatabad Medical Complex, Peshawar, Pakistan
Yousaf Jan Department of Surgery, Hayatabad Medical Complex, Peshawar, Pakistan
Mohsin Ali Department of Surgery, Hayatabad Medical Complex, Peshawar, Pakistan
. Fazalullah Department of Surgery, Hayatabad Medical Complex, Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i5.2250

Keywords:

Incisional Surgical Site Infection, Open Appendectomy, Complicated Appendicitis, Rural Residence, Pakistan

Abstract

Surgical site infection (SSI) is a common postoperative complication following appendectomy, particularly in cases of complicated appendicitis. SSIs contribute to increased morbidity, prolonged hospital stay, and higher healthcare costs. Identifying the frequency and associated risk factors is essential for improving surgical outcomes. Objective: To determine the frequency of incisional surgical site infection in patients undergoing open appendectomy for complicated appendicitis. Methods: This cross-sectional study was conducted on 137 patients aged 18–60 years of either gender diagnosed with complicated appendicitis and undergoing open appendectomy conducted in the department of surgery, Hayatabad Medical Complex, Peshawar, from 8 October 2024 to 08 March 2025. Patients with chronic medical or psychiatric illnesses, hemodynamic instability, coagulation disorders, cirrhosis, active systemic infection, or pregnancy were excluded. All patients underwent open surgical appendectomy, and incisional surgical site infection was assessed within 30 days postoperatively. SSI was defined as the presence of swelling, pain (visual analog scale >3), fever >38.5°C, and purulent discharge from the incision. Data were analyzed using SPSS version 23. Associations between variables were assessed using the chi-square test, with a significance level set at p < 0.05. Results: A total of 137 patients were included, with a mean age of 39.36 ± 12.21 years and a mean body mass index of 26.96 ± 2.67 kg/m². There were 80 (58.4%) males and 57 (41.6%) females. Incisional surgical site infection occurred in 30 patients, representing 21.9% of cases. A statistically significant association was found between SSI and rural residence (p = 0.047). No significant associations were observed with other demographic variables. Conclusion: The frequency of incisional surgical site infection following open appendectomy for complicated appendicitis was relatively high (21.9%). Rural residence was significantly associated with increased risk. Targeted preventive strategies and improved postoperative care, particularly in resource-limited settings, may help reduce the burden of SSI.

Downloads

Download data is not yet available.

57

References

1. Shinwari H, Ewalds-Kvist BM, El Boghdady M. Postoperative antibiotic strategies in acute complicated appendicitis: a systematic review. Updates Surg. 2025;77:2385-95. DOI: https://doi.org/10.1007/s13304-025-02327-6

2. Leandri M, Vallicelli C, Santandrea G, Perrina D, Bravi F, Sartelli M, et al. Postoperative infections after appendectomy for acute appendicitis: the surgeon’s checklist. Antibiotics (Basel). 2025;14(9):954. DOI: https://doi.org/10.3390/antibiotics14090954

3. Akash A, Saxena N. Superficial surgical site infection in delayed primary vs primary wound closure in complicated appendicitis. Pol Przegl Chir. 2023;96:123-9. DOI: https://doi.org/10.5604/01.3001.0053.6850

4. Danwang C, Bigna JJ, Tochie JN, Mbonda A, Mbanga CM, Nzalie RN, et al. Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis. BMJ Open. 2020;10(2):e034266. DOI: https://doi.org/10.1136/bmjopen-2019-034266

5. Fayraq A, Alzahrani SA, Alsayaf Alghamdi AG, Alzhrani SM, Alghamdi AA, Abood HB. Risk factors for post-appendectomy surgical site infection in laparoscopy and laparotomy: retrospective cohort study. Cureus. 2023;15(8):e44237. DOI: https://doi.org/10.7759/cureus.44237

6. Kamath R, Kumar AS, Bari T, RJ V, Kamath S, Sugunan A, et al. Risk factors for surgical site infections after paediatric appendectomies in a tertiary care teaching hospital in coastal Karnataka. F1000Res. 2025;14:565. DOI: https://doi.org/10.12688/f1000research.163894.1

7. Azmeraw M, Temesgen D, Kitaw TA, Feleke SF, Haile RN, Kassaw A, et al. Surgical site infection following appendectomy in children. Sci Rep. 2025;15(1):6321. DOI: https://doi.org/10.1038/s41598-024-79939-2

8. Dobel AA, Alkhaldi NA, Alkharashi AA, Aljamaan NH, Mahfouz MEM. Postoperative complications following appendectomy: a single-center retrospective study. Cureus. 2024;16(9):e70219. DOI: https://doi.org/10.7759/cureus.70219

9. Pitesa R, Paterson C, Flaherty M, Eteuati J, Hill AG. Complicated appendicitis in low- and lower-middle-income countries: a systematic review and meta-analysis. ANZ J Surg. 2025;95(6):1096-107. DOI: https://doi.org/10.1111/ans.70103

10. Ullah A, Bangash AN. Surgical site infection among patients undergoing appendectomy by utilizing antimicrobial coated suture. Pak J Intens Care Med. 2025;5(2):184. DOI: https://doi.org/10.54112/pjicm.v5i02.184

11. Mohamed AE, El-Moneim A, Abd El-Hamid A, Emam MA. Comparative study between open surgical technique versus laparoscopic appendectomy in complicated appendicitis. Al-Azhar Int Med J. 2022;3(2):76-81. DOI: https://doi.org/10.21608/aimj.2022.108248.1687

12. Salman M, Saeeda, Khan M, Rahman NU. Surgical site infections prevalence after the appendectomy of complicated appendicitis. Rehman J Health Sci. 2023;5(2):152-8.

13. Aslam F, Arif AU, Ahmad N, Rehman SSU, Daud M, Burki HAB. Frequency of surgical site infection in patients undergoing open appendectomy in complicated appendicitis. J Health Wellness Community Res. 2025;3(8):e485. DOI: https://doi.org/10.61919/ng7apf29

14. Firdos R, Abdi IH, Laghari QA, Sahito MUR, Kalhoro N. Correlation of surgical site infection after appendicectomy with per-operative morphological appearance of appendix. Prof Med J. 2020;27(2):251-9. DOI: https://doi.org/10.29309/TPMJ/2020.27.02.3231

15. Iqbal S, Iftikhar M, Qureshi HU, Khan AG, Ullah S. Frequency of surgical site infection after appendicectomy. J Peoples Univ Med Health Sci Nawabshah. 2024;14(3):32-7.