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Meta-Analysis
. 2020 Feb 18;10(2):e034266.
doi: 10.1136/bmjopen-2019-034266.

Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis

Celestin Danwang  1   2 , Jean Joel Bigna  3 , Joel Noutakdie Tochie  4 , Aimé Mbonda  5 , Clarence Mvalo Mbanga  6 , Rolf Nyah Tuku Nzalie  7 , Marc Leroy Guifo  2 , Arthur Essomba  2
Affiliations
Meta-Analysis

Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis

Celestin Danwang et al. BMJ Open. .

Abstract

Background: Although surgical site infection (SSI) is one of the most studied healthcare-associated infections, the global burden of SSI after appendectomy remains unknown.

Objective: We estimated the incidence of SSI after appendectomy at global and regional levels.

Design: Systematic review and meta-analysis.

Participants: Appendectomy patients.

Data sources: EMBASE, PubMed and Web of Science were searched, with no language restrictions, to identify observational studies and clinical trials published between 1 January 2000 and 30 December 2018 and reporting on the incidence of SSI after appendectomy. A random-effect model meta-analysis served to obtain the pooled incidence of SSI after appendectomy.

Results: In total, 226 studies (729 434 participants from 49 countries) were included in the meta-analysis. With regard to methodological quality, 59 (26.1%) studies had low risk of bias, 147 (65.0%) had moderate risk of bias and 20 (8.8%) had high risk of bias. We found an overall incidence of SSI of 7.0 per 100 appendectomies (95% prediction interval: 1.0-17.6), varying from 0 to 37.4 per 100 appendectomies. A subgroup analysis to identify sources of heterogeneity showed that the incidence varied from 5.8 in Europe to 12.6 per 100 appendectomies in Africa (p<0.0001). The incidence of SSI after appendectomy increased when the level of income decreased, from 6.2 in high-income countries to 11.1 per 100 appendectomies in low-income countries (p=0.015). Open appendectomy (11.0 per 100 surgical procedures) was found to have a higher incidence of SSI compared with laparoscopy (4.6 per 100 appendectomies) (p=0.0002).

Conclusion: This study suggests a high burden of SSI after appendectomy in some regions (especially Africa) and in low-income countries. Strategies are needed to implement and disseminate the WHO guidelines to decrease the burden of SSI after appendectomy in these regions.

Prospero registration number: CRD42017075257.

Keywords: Public health; epidemiology; health policy; quality in health care.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Global incidence of surgical site infection after appendectomy, by level of country income.SSI: surgical-site infection; C.I.: confidence intervals.
Figure 2
Figure 2
Global incidence of surgical site infection after appendectomy, by WHO region.SSI: surgical-site infection; C.I.: confidence intervals.
Figure 3
Figure 3
Global incidence of surgical site infection after appendectomy, by type of surgical procedure.SSI: surgical-site infection; C.I.: confidence intervals.
See this image and copyright information in PMC

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