Utilization of a specimen retrieval bag during laparoscopic appendectomy for both uncomplicated and complicated appendicitis is not associated with a decrease in postoperative surgical site infection rates

Abstract

Background: To determine whether utilization of a retrieval bag during laparoscopic appendectomy for uncomplicated and complicated appendicitis (perforation/abscess) is associated with postoperative surgical site infection rates.

Methods: We studied patients presented in the database of the 2016 Appendectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program who underwent laparoscopic appendectomy for pathology-confirmed appendicitis. The primary predictor variable was intraoperative utilization of a specimen retrieval bag for removal of the appendix from the peritoneal cavity. The primary outcome variable was 30-day postoperative surgical site infection. Logistic regression analysis was used to determine the association between use of a specimen retrieval bag and postoperative surgical site infection rate after adjustment for patient- and disease-related variables.

Results: A total of 10,357 patients were included for analysis. Of these procedures, 9,585 (92.6%) included the use of a specimen bag and 772 (7.5%) did not. The 30-day incidence of postoperative surgical site infection was 4.2% in the group in which no bag was used and 3.6% in the group in which a bag was used (adjusted odds ratio of surgical site infection with no bag utilization was 1.15 [95% confidence interval 0.78-1.69; P = .49]). The lack of a statistically significant association between bag utilization and postoperative surgical site infection incidence was also demonstrated for a subgroup of patients with perforated appendicitis.

Conclusion: Utilization of a retrieval bag during laparoscopic appendectomy is not associated with a statistically significant decrease in postoperative surgical site infection for either uncomplicated or complicated acute appendicitis.