Effects Of Perioperative Hyperoxygenation On Surgical Site Infection In Patients With Acute Appendicitis

Abstract

INTRODUCTION Surgical wound infection is nightmare for any surgeon following elective and emergency operations. In recent studies, the possibility of reducing Surgical site infection(SSI) by perioperative hyperoxygenation has been raised. Hypoxia at the level of local wound site retards proper healing. Proper oxygenation of the tissue through microcirculation is vital for the healing process and for resistance to infection. The data obtained from the related randomized, controlled trials for the benefits of perioperative hyperoxygenation to reduce SSI remain controversial. To overcome this problem, we have performed a randomized, controlled trial in a patient population with a single diagnosis (acute appendicitis), using standard surgical approach (open appendicectomy). AIMS AND OBJECTIVE To know the effects of hyperoxygenation on surgical site infection following open appendicectomy in the patient having acute appendicitis in forms of ASEPSIS criteria, duration of hospital stay and cost effectiveness. MATERIAL AND METHODS This was a prospective case control study conducted at BLDEU’s shri B. M. Patil Medical College Hospital and Research Centre, Vijayapur from Oct 2015 to Aug 2017 and included 180 patients with Acute appendicitis and in each group 90 patients were allotted. A total of 180 patients who underwent open surgery for acute appendicitis, Preoperative intravenous antibiotics were given to all patients. In the control group, 90 patients received oxygen from the room air, while in the study group, the fraction of inspired oxygen(FIO2) reached 80% with the use of nonrebreathing mask in the rest 90 patients and continued for 2 hours in the recovery XI room following completion of the operation in the study group with high-flow oxygen (10 L/min) through a nonrebreathing mask, while control group received oxygen from room air. We used the ASEPSIS system score to assess the degree of healing and infection of the surgical wound. The results of the two groups were compared and analyzed. RESULTS The post operative SSI according to ASESPIS criteria, mean hospitalization, use of antibiotics and cost effectiveness were assessed and P values derived and compared between the two groups. In our study we noticed marked difference in requirement of antibiotic in control group (98.9%) as compare to study group (1.1%) making it significant. In study group 5 (5.6%) patients had surgical site infection while in control group 17 (18.9%) patients had surgical site infection as per ASEPSIS score. Control group has average stay of 7.6+2 days while study group has 6.4+2.4 days which is statistically lower in study group. Cost of treatment in study group is significantly lower than the control group.

CONCLUSION The use of perioperative hyperoxygenation is advantageous in operations for acute appendicitis. As this is the most common emergent operation in general surgery, decreasing the rate of SSI carries significant clinical and economical gains in the form of judicious use of antibiotics, shorter hospital stay and cost effectiveness. In addition, as our study was conducted in a relatively homogeneous study population, our results support the beneficial effects of supplemental oxygen in clean contaminated surgery in general.