Evaluation of surgical site infection surveillance as a Prognostic Tool in acute appendicitis

Declan Ryan; S. Nolan; N. Doyle

doi:10.5281/zenodo.22813516

Authors

Declan Ryan Division of General Surgery, Snake Academy of Surgical Research Author https://orcid.org/3753-8749-8523-4195
S. Nolan Department of Clinical General Surgery, Mekong Institute for Advanced Surgical Research Author https://orcid.org/8597-1966-9506-3519
N. Doyle Division of General Surgery, Neva Research Center for General Surgery Author https://orcid.org/6374-9118-0176-2544

DOI:

https://doi.org/10.5281/zenodo.22813516

Keywords:

Surgical site infection, Appendicitis, Appendectomy, Surveillance, Prognosis

Abstract

Graphical abstract

Background: Whether routinely captured surgical site infection (SSI) surveillance data carry independent prognostic value for outcomes after appendectomy for acute appendicitis has not been well characterized. This study evaluated NHSN-defined SSI surveillance status as a predictor of adverse postoperative trajectory.

Methods: We conducted a retrospective cohort study of 512 adults undergoing appendectomy for acute appendicitis at three affiliated centers (2019-2024). SSI status was assigned using NHSN criteria, and its association with 30-day reoperation, unplanned readmission, prolonged length of stay, and 90-day mortality was assessed by multivariable logistic regression adjusted for wound class, ASA class, approach, and perforation status.

Results: SSI occurred in 54 of 512 patients (10.5%). SSI surveillance status was independently associated with 30-day reoperation (adjusted odds ratio [aOR] 6.8, 95% CI 3.1-14.9), readmission (aOR 5.2, 95% CI 2.6-10.4), and prolonged length of stay (aOR 4.4, 95% CI 2.3-8.6). A composite model adding SSI status to perforation and ASA class achieved an AUC of 0.81 for reoperation, versus 0.68 for perforation alone.

Conclusion: Structured SSI surveillance carries meaningful independent prognostic information for early adverse outcomes after appendectomy and may help identify patients warranting closer postoperative follow-up.

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