Comparison of primary wound closure versus open wound management in perforated appendicitis.
OBJECTIVE
Open wound management has long been the most common practice after appendectomy for perforated appendicitis. Primary closure, however, has recently been advocated to reduce cost and morbidity. The aim of this study was to compare the results of open wound management and primary wound closure in adult patients (age, > or =15 years) with perforated appendicitis.


METHODS
Hospital records of 390 patients (age, > or =15 years) who underwent appendectomy between January 2002 and December 2004 were reviewed to identify surgical wound infection (SWI) and pathologic diagnosis. Perforated appendicitis was the indication for appendectomy in 65 of these patients. The incision wounds in these 65 patients were closed primarily in 41 and left open at the end of the operation in 24. The duration of symptoms, white blood cell count, operative time, incidence of SWI, length of stay (LOS) and readmission rate were compared between patients with these two different methods of wound management.


RESULTS
Patients whose wounds were closed primarily had a higher incidence of SWI (43.9% vs. 4.2%, p < 0.001) and longer LOS (10 days vs. 7.9 days, p = 0.044). The readmission rate was also higher for patients whose wounds were closed primarily; however, this difference was not significant.


CONCLUSIONS
Open wound management may be preferable to primary wound closure for perforated appendicitis in adults because of a lower incidence of SWI and a shorter LOS. Randomized clinical trials, however, are needed to establish these findings.
Chiang
Ruey-An
RA
Department of Surgery, Mackay Memorial Hospital, Taitung Branch, No. 1 Lane 303 Chang-Sha Street, Taitung 950, Taiwan. ryan@ttms.mmh.org.tw
Chen
Shan-Long
SL
Tsai
Yao-Chung
YC
Bair
Ming-Jong
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D014945:Wound Healing
D000900:Anti-Bacterial Agents