S. A. Turner1, H. Jung1, J. E. Scarborough1 1University of Wisconsin – Madison,General Surgery,Madison, WI, USA
Introduction: Specimen retrieval bags are routinely used in laparoscopic appendectomy under the assumption that they help to prevent surgical site infection (SSI). Little if any evidence has been published to support this assumption.
Methods: Patients from the 2016 Appendectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program database who underwent laparoscopic appendectomy for pathology-confirmed appendicitis were included in this study. The primary predictor variable for our analysis was intraoperative utilization of a specimen retrieval bag for appendix removal (as documented in the operative report). Additional predictor variables included patient and disease characteristics, including the presence of perforated appendicitis and/or the presence of a peri-appendiceal abscess. The primary outcome variable for our analysis was 30-day postoperative SSI (including incisional and/or organ/space SSI). Logistic regression analysis was used to determine the association between specimen retrieval bag utilization and postoperative SSI rate, after adjustment for patient- and disease-related variables.
Results: A total of 10,357 patients were included for analysis, 9,585 (92.6%) whose procedure included specimen bag utilization (BAG) and 772 (7.5%) whose procedure did not (NO BAG). The 30-day incidence of postoperative SSI was 4.2% in the NO BAG group and 3.6% in the BAG group [AOR of SSI without bag utilization 1.15 (95% CI 0.78-1.69; P = 0.49)]. The lack of a statistically significant association between bag utilization and postoperative SSI incidence was also demonstrated for a subgroup of patients with perforated appendicitis.
Conclusion: Although widely assumed to prevent postoperative SSI, specimen bag utilization during laparoscopic appendectomy does not appear to provide any overt benefit to patients. Eliminating the routine use of these devices will improve therefore improve the value of this common operation.