Publication:

Intraoperative irrigation in contaminated appendectomy: balancing antimicrobial efficacy and tissue viability from a reconstructive surgery perspective

Background Surgical site infection (SSI) remains a major determinant of postoperative morbidity. Traditional preventive strategies focus on antimicrobial control; however, emerging surgical paradigms emphasize tissue viability and wound biology. To evaluate the impact of intraoperative irrigation (povidone-iodine vs saline) on SSI following appendectomy, integrating perioperative variables within a reconstructive framework.

Methods Retrospective comparative study including patients aged 18–60 years undergoing appendectomy for stage II–IV appendicitis. Variables included irrigation type, SSI occurrence, operative time, incision type, antibiotic regimen and duration and timing of infection onset. SSI was defined according to CDC criteria. Statistical analyses included Fisher’s exact test and exploratory Firth logistic regression.

Results Thirty-one patients were included (saline n=22, povidone-iodine n=9). SSI occurred in 9.7% (3/31), with no cases observed in the povidone-iodine group (13.6% vs 0%, p=0.54). All SSI cases occurred in patients with complicated appendicitis and midline incisions. Median antibiotic duration was significantly longer in SSI patients (16 vs 10 days, p=0.016). SSI onset occurred on postoperative days 7 and 20. No significant association was observed between operative time and SSI.

Conclusions SSI following appendectomy is a multifactorial outcome. Strategies balancing antimicrobial control with preservation of tissue viability may optimize postoperative outcomes.