Publication:

Efficacy and safety of abdominal cavity cleansing with chlorhexidine for reducing surgical site infection in patients undergoing appendectomy

Background Surgical site infection (SSI) remains a relevant postoperative complication after appendectomy. Intraoperative abdominal cavity cleansing is used in clinical practice, but the evidence supporting antiseptic solutions remains heterogeneous.

Methods A prospective case-control study was conducted in adults undergoing appendectomy for acute appendicitis at a tertiary hospital in Puebla, Mexico. Patients received intraoperative abdominal cavity cleansing with either chlorhexidine or saline. The primary outcome was surgical site infection within 30 days. Patients were followed at 15 and 30 days postoperatively. Demographic, clinical, microbiological, and adverse-event data were collected. Associations were analyzed using odds ratios with 95% confidence intervals and Fisher’s exact test, with p<0.05 considered statistically significant.

Results The median age was 37 years (IQR 26-51); 217 patients (55.5%) were women and 174 (44.5%) were men. Uncomplicated and complicated appendicitis occurred in 198 (50.6%) and 193 (49.4%) patients, respectively. Postoperative complications occurred in 97/192 (50.5%) patients in the chlorhexidine group and 58/108 (53.7%) in the saline group. Chlorhexidine showed a non-significant trend toward fewer complications (OR 0.88, 95% CI 0.55-1.41; p=0.63). Mean time to infection was 16.3±8.4 days. The most frequent positive isolate was Escherichia coli. No increase in adverse events was observed with chlorhexidine.

Conclusions Abdominal cavity cleansing with chlorhexidine was clinically safe and showed a non-significant trend toward fewer postoperative complications compared with saline. These findings support further adequately powered randomized studies to define its role in SSI prevention after appendectomy.