Adam C Fields1, Pamela Lu2, Deanna L Palenzuela3, Ronald Bleday3, Joel E Goldberg3, Jennifer Irani3, Jennifer S Davids4, Nelya Melnitchouk5. 1. Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: acfields@partners.org. 2. Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 3. Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 4. Department of Surgery, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester. 5. Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: nmelnitchouk@bwh.harvard.edu.
Abstract
BACKGROUND: Appendectomy is the most commonly performed emergency operation in the United States, with approximately 370,000 patients undergoing the procedure every year. Although laparoscopic appendectomy is associated with decreased complications when compared with open appendectomy, the risk for infectious complications, including surgical site infection, intra-abdominal abscess, and sepsis, remains a significant source of postoperative morbidity and health care cost. The goal of this study is to determine whether the appendix retrieval technique during laparoscopic appendectomy affects risk of infectious complications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database and the Appendectomy Procedure Targeted database were used to conduct this retrospective study. Patients who underwent laparoscopic appendectomy in 2016 were identified. The primary outcomes were infectious complications of superficial site infection and intra-abdominal abscess. RESULTS: A total of 10,578 (92.2%) patients underwent laparoscopic appendectomy using an appendix retrieval bag and 897 (7.8%) patients underwent laparoscopic appendectomy without an appendix retrieval bag. There was no significant difference in preoperative sepsis, smoking status, wound class, complicated appendicitis, or American Society of Anesthesiologists class between patient groups (all P > .05). In the univariate analysis, there was no difference in the rate of superficial site infection (0.9% vs 0.6%, P = .28) or intra-abdominal infection (2.7% vs 3.8%, P = .06) between retrieval bag use and non-use. In the multivariable analysis, appendix retrieval bag use was an independent predictor of intra-abdominal infection and associated with a 40% decrease in intra-abdominal infection rates (odds ratio: 0.6, 95% confidence interval: 0.42-0.95, P = .03). CONCLUSION: Appendix retrieval bags are associated with a decreased risk of postoperative intra-abdominal abscess. The use of appendix retrieval bags should be the standard of care during laparoscopic appendectomy.
BACKGROUND: Appendectomy is the most commonly performed emergency operation in the United States, with approximately 370,000 patients undergoing the procedure every year. Although laparoscopic appendectomy is associated with decreased complications when compared with open appendectomy, the risk for infectious complications, including surgical site infection, intra-abdominal abscess, and sepsis, remains a significant source of postoperative morbidity and health care cost. The goal of this study is to determine whether the appendix retrieval technique during laparoscopic appendectomy affects risk of infectious complications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database and the Appendectomy Procedure Targeted database were used to conduct this retrospective study. Patients who underwent laparoscopic appendectomy in 2016 were identified. The primary outcomes were infectious complications of superficial site infection and intra-abdominal abscess. RESULTS: A total of 10,578 (92.2%) patients underwent laparoscopic appendectomy using an appendix retrieval bag and 897 (7.8%) patients underwent laparoscopic appendectomy without an appendix retrieval bag. There was no significant difference in preoperative sepsis, smoking status, wound class, complicated appendicitis, or American Society of Anesthesiologists class between patient groups (all P > .05). In the univariate analysis, there was no difference in the rate of superficial site infection (0.9% vs 0.6%, P = .28) or intra-abdominal infection (2.7% vs 3.8%, P = .06) between retrieval bag use and non-use. In the multivariable analysis, appendix retrieval bag use was an independent predictor of intra-abdominal infection and associated with a 40% decrease in intra-abdominal infection rates (odds ratio: 0.6, 95% confidence interval: 0.42-0.95, P = .03). CONCLUSION: Appendix retrieval bags are associated with a decreased risk of postoperative intra-abdominal abscess. The use of appendix retrieval bags should be the standard of care during laparoscopic appendectomy.
Authors: Kovi E Bessoff; Jeff Choi; Christopher J Wolff; Aditi Kashikar; Garrison M Carlos; Luke Caddell; Rida I Khan; Christopher D Stave; David A Spain; Joseph D Forrester Journal: Surg Open Sci Date: 2021-08-26
Authors: Balazs Aczel; Barnabas Szaszi; Gustav Nilsonne; Olmo R van den Akker; Casper J Albers; Marcel Alm van Assen; Jojanneke A Bastiaansen; Daniel Benjamin; Udo Boehm; Rotem Botvinik-Nezer; Laura F Bringmann; Niko A Busch; Emmanuel Caruyer; Andrea M Cataldo; Nelson Cowan; Andrew Delios; Noah Nn van Dongen; Chris Donkin; Johnny B van Doorn; Anna Dreber; Gilles Dutilh; Gary F Egan; Morton Ann Gernsbacher; Rink Hoekstra; Sabine Hoffmann; Felix Holzmeister; Juergen Huber; Magnus Johannesson; Kai J Jonas; Alexander T Kindel; Michael Kirchler; Yoram K Kunkels; D Stephen Lindsay; Jean-Francois Mangin; Dora Matzke; Marcus R Munafò; Ben R Newell; Brian A Nosek; Russell A Poldrack; Don van Ravenzwaaij; Jörg Rieskamp; Matthew J Salganik; Alexandra Sarafoglou; Tom Schonberg; Martin Schweinsberg; David Shanks; Raphael Silberzahn; Daniel J Simons; Barbara A Spellman; Samuel St-Jean; Jeffrey J Starns; Eric Luis Uhlmann; Jelte Wicherts; Eric-Jan Wagenmakers Journal: Elife Date: 2021-11-09 Impact factor: 8.140