Randomized Trial of Primary Versus Delayed Closure of Contaminated Appendectomy Incisions
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Abstract
Wound infection is common following contaminated appendicectomy incisions in developing countries with an increased cost of treatment. We set out to determine the wound infection outcome and costs of managing contaminated appendicectomy incisions closed primarily as compared to those closed using a technique of delayed primary closure.Forty-ninepatients with acute uncomplicated appendicectomy were randomized into two groups. The first group had primary closure and the second group delayed primary closure of their incisions following operative management. Postoperative monitoring for wound infection was done for one month. The overall cost of wound management and the length of hospital stay were then determined. Twenty-five(51%) and 24 (49%) matched patients were assigned to the primary and delayed primary closure group respectively. Wound infection in both groups was20% and 4.2% respectively. The mean cost of wound management was fourteen thousand, seven hundred and sixty-four naira only (N 14,764.00), and twelve thousand, one hundred and forty-eight naira only (N 12, 148.33) respectively. The mean length of hospital stay was 3.20 days and 2.58 days respectively. In conclusion, primary closure and delayed primary closure of contaminated appendicectomy incisions result in similar wound infection outcomes, cost of wound management and length of hospital stay. However, there was a numerical trend in favour of delayed primary closure when the primary outcomes were considered. We recommend that in operative management of contaminated appendicectomy wounds, both methods of wound closure are acceptable and clinical judgement should guide the surgeon's choice.
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References
Mangram A, Horan T, Pearson M, Silver S, Jarvis W. Prevention of surgical site infection. Infect Control Hosp Epidermiol. 1999;20(4):24778.
Coller F, Valk W. The delayed closure of contaminated wounds. Ann Surg. 1940;112(2):25670.
Manring MM, Hawk A, Calhoun JH, Andersen RC. Treatment of war wounds: A historical review. Clin OrthopRelat Res. 2009;467(8):216891.
Burnweit BC, Bilik R, Shandling B. Wounds in Perforated Appendicitis. J Pediatr Surg. 1991;26(12):13625.
Ussiri E, Mkony C, Aziz M. Surgical wound infection in clean-contaminated and contaminated laparotomy wounds at Muhimbili National Hospital. East Cent African J Surg. 2005;10(2):1923.
Usang UE, Sowande OA, Ademuyiwa AO, Bakare TB, Adejuyigbe O. Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria. Afr J Paediatr Surg. 2009;6(1):314.
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):13641.
Siribumrungwong B, Noorit P, Wilasrusmee C, Thakkinstian A. A systematic review and meta-analysis of randomised controlled trials of delayed primary wound closure in contaminated abdominal wounds. World J Emerg Surg. 2014;9(1):4957.
Khan KI, Mahmood S, Akmal M, Waqas A. Comparison of rate of surgical wound infection, length of hospital stay and patient convenience in complicated appendicitis between primary closure and delayed primary closure. J Pak Med Assoc. 2012;62(8):5968.
Henry MW, Moss RL. Primary versus delayed wound closure in complicated appendicitis: An international systematic review and meta-analysis. PediatrSurg Int. 2005;21(8):62530.
Ussiri E, Mkony C, Aziz M. Sutured and Open Clean-Contaminated and Contaminated Laparotomy Wounds at Muhimbili National Hospital: A Comparison of Complications. East and Central African J Surg 2004; 9(2): 89-95.
Ameh EA, Mshelbwala PM, Nasir AA, Lukong CS, Jabo BA, Anumah MA, et al. Surgical site infection in children: prospective analysis of the burden and risk factors in a sub-Saharan African setting. Surg Infect (Larchmt). 2009;10(2):1059.
Cohn SM, Giannotti G, Ong AW, Varela JE, Shatz D V, Mckenney MG, et al. Prospective Randomized Trial of Two Wound Management Strategies for Dirty Abdominal Wounds. Ann Surg. 2001;233(3):40913.
Oliver J, Al-Mufti R. The prolene zip technique: prevention of wound infections in contaminated abdominal incisions. Ann R Coll Surg England. 2005;87:3834.
Alatise O, Ogunweide T. Acute Appendicitis: Incidence and Management in Nigeria. J Obafemi Awolowo Univ Med Student's Assoc. 2008;14(1):66-70
Ali N, Aliyu S. Appendicitis and its surgical management experience at the University of Maiduguri Teaching Hospital Nigeria. Niger J Med. 2012;21(2):2236.
He JC, Zosa BM, Schechtman D, Brajcich B, Savakus JC, Wojahn AL, et al. Leaving the Skin Incision Open May Not Be as Beneficial as We Have Been Taught. Surg Infect (Larchmt). 2017;18(4). 431-9
Osakwe JO, Nnaji GA, Osakwe RC, Agu U, Chineke HN. Role of premorbid status and wound related factors in surgical site infection in a tertiary hospital in sub-saharan Africa. Fam Pract Reports. 2014;1(1):17.
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. Surg Infect (Larchmt). 2009;10(2):12936.
Gottrup F, Melling A, Hollander D. An overview of surgical site infections: aetiology, incidence and risk factors. EWMA J. 2005;5(2):115.
Urbaniak GC, Plous S. Research Randomizer version 4.0 Computer software (2013). Date accessed:Feb. 8th 2018. Available at: http://www.randomizer.org/.
Farquharson M, Brendan M. Classic operations on the small and large bowel. In: Margaret F, Brendan M, editors. Farquharson's textbook of operative general surgery. 9th ed. London: Edward Arnold (Publishers) Ltd; 2005. p. 37983.
Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60(1):2740.
Tsang TM, Tam PK, Saing H. Delayed primary wound closure using skin tapes for advanced appendicitis in children. A prospective, controlled study. Arch Surg. 1992;127:4513.
Siribumrungwong B, Srikuea K, Thakkinstian A. Comparison of superficial surgical site infection between delayed primary and primary wound closures in ruptured appendicitis. Asian J Surg. 2014;37:1204.
Pettigrew RA. Delayed primary wound closure in gangrenous and perforated appendicitis. Br J Surg. 1981;68(1981):6358.
Chatwiriyacharoen W. Surgical wound infection post surgery in perforated appendicitis in children. J Med Assoc Thai. 2002;85(5):5726.
Tobin R. Closure of contaminated wounds. Biologic and technical considerations. Surg Clin North Am. 1984;64(4):63952.
Olu-bode C. Primary versus Delayed primary closure in Dirty Abdominal wounds. Dissertation. National Postgraduate Medical College of Nigeria; 1991. p.1-60
Chiang RA, Chen SL, Tsai YC. Delayed primary closure versus primary closure for wound management in perforated appendicitis: A prospective randomized controlled trial. J Chinese Med Assoc. 2012;75(4):1569.
Shuaibu AS, Ibrahim YE, Olayinka BO, Atata RF, Oyeniyi J, Shuaibu BA. Retrospective Study on the Prevalence of Surgical Wound Infections in Specialist Hospital Sokoto North West Nigeria. J Adv Med Pharm Sci. 2017;13(2):1-7.
Inyang AW. Primary versus Delayed Primary closure of laparotomy wounds in children following Intestinal perforation in Ile-Ife. Dissertation. National Postgraduate Medical College of Nigeria; 2010. p.1-43
Ahmad M, Ali K, Latif H, Naz S, Said K. Comparison of Primary Wound Closure With Delayed Primary Closure in Perforated Appendicitis. J Ayub Med Coll Abbottabad. 2014;26(2):1537.
Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86:2433.