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Title: Comparison of Superficial Surgical Site Infection between Delayed Primary Versus Primary Wound Closure in Complicated Appendicitis
Authors: Boonying Siribumrungwong
Anuwat Chantip
Pinit Noorit
Chumpon Wilasrusmee
Winai Ungpinitpong
Pradya Chotiya
Borwornsom Leerapan
Patarawan Woratanarat
Mark McEvoy
John Attia
Ammarin Thakkinstian
Chonburi Regional Hospital
Surin Hospital
University of Newcastle, Faculty of Health and Medicine
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Faculty of Medicine, Thammasat University
Pathum Thani Hospital
Lampang Regional Hospital
Keywords: Medicine
Issue Date: 1-Apr-2018
Citation: Annals of Surgery. Vol.267, No.4 (2018), 631-637
Abstract: © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. 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.
ISSN: 15281140
Appears in Collections:Scopus 2018

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