title: [Post-appendectomy surgical site infection: overall rate and type according to open/laparoscopic approach].
abstract: OBJECTIVE
  To compare the incidence and profile of surgical site infection (SSI) after laparoscopic (LA) or open (OA) appendicectomy.
  
  
  METHODS
  Observational and analytical study was conducted on patients older than 14years-old with suspected acute appendicitis operated on within a 4-year period (2007-2010) at a third level hospital (n=868). They were divided in two groups according to the type of appendicectomy (LA, study group, 135; OA, control group, 733). The primary endpoint was a surgical site infection (SSI), and to determine the overall rate and types (incisional/organ-space). The risk of SSI was stratified by: i)National Nosocomial Infection Surveillance (NNIS) index (low risk: 0E, 0 and 1; high risk: 2 and 3); ii)status on presentation (low risk: normal or phlegmonous; high risk: gangrenous or perforated). The statistical analysis was performed using the software SPSS. The main result and stratified analysis was determined with χ(2), and the risk parameters using OR and Mantel-Haenszel OR with 95%CI, accepting statistical significance with P<.05.
  
  
  RESULTS
  Age, gender, ASA index and incidence of advanced cases were similar in both groups. The overall SSI rate was 13.4% (more than a half of them detected during follow-up after discharge). Type of SSI: OA, 13% (superficial 9%, deep 2%, organ-space 2%); AL, 14% (superficial 5%, deep 1%, organ-space 8%) (overall: not significant; distribution: P<.000). Stratified analysis showed that there is an association between incisional SSI/OA and organ-space SSI/LA, and is particularly stronger in those patients with high risk of postoperative SSI (high risk NNIS or gangrenous-perforated presentation).
  
  
  CONCLUSIONS
  OA and LA are associated with a higher rate of incisional and organ-space SSI respectively. This is particularly evident in patients with high risk of SSI.
authors.affiliation: Unidad de Gestión Clínica de Cirugía General, Digestiva y Trasplante, Hospital Regional Universitario Carlos Haya, Málaga, España. Electronic address: josearanda68@telefonica.net.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Aranda-Narváez
authors.affiliation: Unidad de Gestión Clínica de Cirugía General, Digestiva y Trasplante, Hospital Regional Universitario Carlos Haya, Málaga, España.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Prieto-Puga Arjona
authors.affiliation: Unidad de Gestión Clínica de Cirugía General, Digestiva y Trasplante, Hospital Regional Universitario Carlos Haya, Málaga, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: García-Albiach
authors.affiliation: Unidad de Gestión Clínica de Cirugía General, Digestiva y Trasplante, Hospital Regional Universitario Carlos Haya, Málaga, España.
authors.forename: María Custodia
authors.initials: MC
authors.lastname: Montiel-Casado
authors.affiliation: Unidad de Gestión Clínica de Cirugía General, Digestiva y Trasplante, Hospital Regional Universitario Carlos Haya, Málaga, España.
authors.forename: Antonio Jesús
authors.initials: AJ
authors.lastname: González-Sánchez
authors.affiliation: Unidad de Gestión Clínica de Cirugía General, Digestiva y Trasplante, Hospital Regional Universitario Carlos Haya, Málaga, España.
authors.forename: Belinda
authors.initials: B
authors.lastname: Sánchez-Pérez
authors.affiliation: Unidad de Gestión Clínica de Cirugía General, Digestiva y Trasplante, Hospital Regional Universitario Carlos Haya, Málaga, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Titos-García
authors.affiliation: Unidad de Gestión Clínica de Cirugía General, Digestiva y Trasplante, Hospital Regional Universitario Carlos Haya, Málaga, España.
authors.forename: Julio
authors.initials: J
authors.lastname: Santoyo-Santoyo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery; D001065:Appendix / Q000473:pathology; D001442:Bacteroides Infections / Q000453:epidemiology / Q000209:etiology; D001441:Bacteroides fragilis; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005734:Gangrene; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012306:Risk; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Acute appendicitis; Apendicectomía laparoscópica; Apendicitis aguda; Infección de sitio quirúrgico; Laparoscopic appendectomy; Surgical site infection