Standardized patient care guidelines reduce infectious morbidity in appendectomy patients.
BACKGROUND
Surgical wound infection and intra-abdominal abscess remain common infectious complications after appendectomy, especially in the setting of a perforated or gangrenous appendix. We therefore developed a clinical protocol for the management of appendicitis to decrease postoperative infectious complications.


METHODS
Between January 1, 1999, and December 31, 1999, 206 patients with appendicitis were treated on protocol. Retrospectively, the charts were reviewed for all protocol patients as well as for 232 patients with appendicitis treated in the year prior to protocol initiation. Data were collected on surgical wound infections and intra-abdominal abscesses.


RESULTS
There were significantly fewer infectious complications in the protocol group than in the nonprotocol group (20 [9%] versus 8 [4%]; P <0.05). In patients with a perforated or gangrenous appendix, the infectious complication rate was reduced from 33% to 13% (P <0.05).


CONCLUSIONS
The incidence of infectious complications after appendectomy can be significantly reduced with a standardized approach to antibiotic therapy and wound management.
Helmer
Kenneth S
KS
Department of Surgery, The University of Texas-Houston Medical School and LBJ General Hospital, 5656 Kelley St., Ste. 3-OS 62008, Houston, TX 77026, USA.
Robinson
Emily K
EK
Lally
Kevin P
KP
Vasquez
J C
JC
Kwong
Karen L
KL
Liu
Terrence H
TH
Mercer
David W
DW
D018784:Abdominal Abscess / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D019072:Antibiotic Prophylaxis; D001062:Appendectomy / Q000009:adverse effects*; D001064:Appendicitis / Q000601:surgery*; D001065:Appendix / Q000473:pathology; D002648:Child; D019317:Evidence-Based Medicine; D005734:Gangrene / Q000473:pathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D010347:Patient Care Planning; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*