- Title
- Comparison of superficial surgical site infection between delayed primary versus primary wound closure in complicated appendicitis: a randomized controlled trial
- Creator
- Siribumrungwong, Boonying; Chantip, Anuwat; Thakkinstian, Ammarin; Noorit, Pinit; Wilasrusmee, Chumpon; Ungpinitpong, Winai; Chotiya, Pradya; Leerapan, Borwornsom; Woratanarat, Patarawan; McEvoy, Mark; Attia, John
- Relation
- Annals of Surgery Vol. 267, Issue 4, p. 631-637
- Publisher Link
- http://dx.doi.org/10.1097/sla.0000000000002464
- Publisher
- Lippincott Williams & Wilkins
- Resource Type
- journal article
- Date
- 2018
- Description
- Objective: To compare superficial surgical site infection (SSI) rates between delayed primary wound closure (DPC) and primary wound closure (PC) for complicated appendicitis. Background: SSI is common in appendectomy for complicated appendicitis. DPC is preferentially used over PC, but its efficacy is still controversial. Methods: A multicenter randomized controlled trial was conducted in 6 hospitals in Thailand, enrolling patients with gangrenous and ruptured appendicitis. Patients were randomized to PC (ie, immediately wound closure) or DPC (ie, wound closure at postoperative days 3-5). Superficial SSI was defined by the Center for Disease Control criteria. Secondary outcomes included postoperative pain, length of stay, recovery time, quality of life, and cost of treatment. Results: In all, 303 and 304 patients were randomized to PC and DPC groups, and 5 and 4 patients were lost to follow-up, respectively, leaving 300 and 298 patients in the modified intention-to-treat analysis. The superficial SSI rate was lower in the PC than DPC groups [ie, 7.3% (95% confidence interval 4.4, 10.3) vs 10% (95% CI 6.6, 13.3)] with a risk difference (RD) of -2.7% (-7.1%, 1.9%), but this RD was not significant. Postoperative pain, length of stay, recovery times, and quality of life were nonsignificantly different with corresponding RDs of 0.3 (-2.5, 3.0), -0.1 (-0.5, 0.3), -0.2 (-0.8, 0.4), and 0.02 (-0.01, 0.04), respectively. However, costs for PC were 2083 (1410, 2756) Baht cheaper than DPC (~$60 USD). Conclusions: Superficial SSI rates for the PC group were slightly lower than DPC group, but this did not reach statistical significance. Costs were significantly lower for the PC group.
- Subject
- appendicitis; delayed primary closure; surgical site infection; wound closure; wound infection
- Identifier
- http://hdl.handle.net/1959.13/1410521
- Identifier
- uon:36199
- Identifier
- ISSN:0003-4932
- Rights
- © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
- Language
- eng
- Full Text
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