Frequency of Surgical Site Infection in Patients Undergoing Open Appendectomy in Complicated Appendicitis

Abstract

Background: Complicated appendicitis presents a significant clinical burden in surgical practice, particularly in resource-limited settings where open appendectomy remains the standard approach. Surgical site infections (SSI) are a common postoperative complication in such cases, contributing to increased morbidity, hospital stay, and readmissions. Despite the global shift toward minimally invasive techniques, data specific to open procedures in high-risk populations remain limited. Objective: To determine the frequency of surgical site infections and identify associated risk factors in patients undergoing open appendectomy for complicated appendicitis. Methods: A descriptive cross-sectional study was conducted at Lady Reading Hospital, Peshawar, from December 2024 to June 2025. A total of 137 patients aged 15–65 years with clinically and radiologically confirmed complicated appendicitis underwent open appendectomy. Data on demographic, clinical, and perioperative variables were collected. Patients were followed for 30 days postoperatively to assess SSI development based on CDC criteria. Statistical analysis included Chi-square, t-tests, and calculation of odds ratios with 95% confidence intervals. Results: The frequency of SSI was 34.3%, with superficial incisional infections comprising the majority (68.1%). Significant risk factors included male gender (OR 2.25), rural residence (OR 3.23), low socioeconomic status (OR 2.94), BMI >25 kg/m² (OR 3.52), and operative time >90 minutes (OR 3.57). SSI was associated with longer hospital stays (8.2 vs 4.6 days, p<0.001) and delayed return to normal activity. Conclusion: SSI rates following open appendectomy for complicated appendicitis remain substantially elevated in resource-constrained environments. Identification of modifiable risk factors provides opportunities for targeted preventive strategies to improve surgical outcomes.