Association of Post-operative Organ Space Infection After Intraoperative Irrigation in Appendicitis

AbstractBackgroundThe benefit of intraoperative irrigation on post-operative absecess rates compared to suction alone is unclear. The American Association for the Surgery of Trauma (AAST) grading system provides distinct disease severity stratification to determine if prior analyses were biased by anatomic severity. We hypothesized that for increasing appendicitis severity, patients receiving (high, ≥2 liter) intraoperative irrigation would have increased post-operative organ space infection (OSI) rate compared to (low, 18 years) undergoing appendectomy for appendicitis during 2010-2016. Demographics, operative details, irrigation volumes, duration of stay, and complications (Clavien-Dindo classification) were collected. AAST grades were assigned by two independent reviewers based on operative findings. Summary, univariate, and area under the reciever operating curve (AUROC) analyses were performed.ResultsPatients (n=1187) were identified with a mean (±SD) age of 41.6±18.4 years (45% female). Operative approach included: laparoscopy (n=1122, 94.5%), McBurney’s incision (n=10, 0.8%), midline laparotomy (n=16, 1.3 %), and laparoscopy converted to laparotomy (n=39, 3.4%). Mean (±SD) volume of intraoperative irrigation was 410±1200 milliliters. Complication rate was 26.1%. Median volume of intraoperative irrigation in patients who developed post-operative OSI was 3 [0-4] compared to 0 [0-0] in those without infection (p18 years) undergoing appendectomy for appendicitis during 2010-2016. Demographics, operative details, irrigation volumes, duration of stay, and complications (Clavien-Dindo classification) were collected. AAST grades were assigned by two independent reviewers based on operative findings. Summary, univariate, and area under the reciever operating curve (AUROC) analyses were performed. Results Patients (n=1187) were identified with a mean (±SD) age of 41.6±18.4 years (45% female). Operative approach included: laparoscopy (n=1122, 94.5%), McBurney’s incision (n=10, 0.8%), midline laparotomy (n=16, 1.3 %), and laparoscopy converted to laparotomy (n=39, 3.4%). Mean (±SD) volume of intraoperative irrigation was 410±1200 milliliters. Complication rate was 26.1%. Median volume of intraoperative irrigation in patients who developed post-operative OSI was 3 [0-4] compared to 0 [0-0] in those without infection (p

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