The Value of Preoperative Chlorhexidine Bath Preceding Appendectomy: Is there a Benefit?
Abstract
Introduction and Objective. Surgical Site Infections (SSIs) increase morbidity and healthcare costs. Pre-operative bathing with an antiseptic agent such as Chlorhexidine (CHG) reduces skin flora and incidence of SSIs for various surgical procedures. Its efficacy in the setting of laparoscopic appendectomy among pediatric patients has not been well established. Developing strategies to decrease SSIs in common procedures, such as laparoscopic appendectomy, has the potential to optimize patient outcomes. Methods. A retrospective chart review of pediatric patients (0-18 years old) who underwent laparoscopic appendectomy for uncomplicated appendicitis between 2017-2022 was conducted. Rates of SSIs between patients who did or did not receive preoperative antiseptic bath with CHG were compared. Additional outcomes included hospital length of stay (LOS) and frequencies of post-operative office calls, unscheduled office visits and emergency room (ER) visits. Descriptive statistics were calculated for all variables. Pearson’s chi-square test or Fisher’s exact test and Mann-Whitney U test were used to assess differences for categorical and continuous variables, respectively. Results were statistically significant at P < 0.05. Results. Of the 89 patients included, 56 (62.9%) underwent pre-operative CHG bath prior to laparoscopic appendectomy (Table 1). While there were no significant differences between demographics for the two cohorts, patients who received pre-operative CHG baths had longer median duration of symptoms prior to appendectomy compared to those who did not receive a pre-operative bath (29 hours vs. 24 hours; P = 0.042). The rate of same-day discharge was similar between the two cohorts (no CHG: 56.3% vs. CHG: 56.1%; P = 0.992). Neither cohort had a SSI recorded and there were no differences in frequencies of calls, unscheduled office visits or ER visits in the post-operative period. Conclusions-Implications. Our work suggests that pre-operative bathing with CHG prior to laparoscopic appendectomy for pediatric patients with uncomplicated appendicitis may not impact outcomes. Additional larger studies may be beneficial to make recommendations and guide the pre-operative care of these patients.
Abstract Category
28. Surgery
Secondary Abstract Category
26. Pediatrics
Keywords
Surgical Site Infections, Appendectomy, Chlorhexidine, Pediatric
Presentation Type
Poster Presentation
The Value of Preoperative Chlorhexidine Bath Preceding Appendectomy: Is there a Benefit?
Introduction and Objective. Surgical Site Infections (SSIs) increase morbidity and healthcare costs. Pre-operative bathing with an antiseptic agent such as Chlorhexidine (CHG) reduces skin flora and incidence of SSIs for various surgical procedures. Its efficacy in the setting of laparoscopic appendectomy among pediatric patients has not been well established. Developing strategies to decrease SSIs in common procedures, such as laparoscopic appendectomy, has the potential to optimize patient outcomes. Methods. A retrospective chart review of pediatric patients (0-18 years old) who underwent laparoscopic appendectomy for uncomplicated appendicitis between 2017-2022 was conducted. Rates of SSIs between patients who did or did not receive preoperative antiseptic bath with CHG were compared. Additional outcomes included hospital length of stay (LOS) and frequencies of post-operative office calls, unscheduled office visits and emergency room (ER) visits. Descriptive statistics were calculated for all variables. Pearson’s chi-square test or Fisher’s exact test and Mann-Whitney U test were used to assess differences for categorical and continuous variables, respectively. Results were statistically significant at P < 0.05. Results. Of the 89 patients included, 56 (62.9%) underwent pre-operative CHG bath prior to laparoscopic appendectomy (Table 1). While there were no significant differences between demographics for the two cohorts, patients who received pre-operative CHG baths had longer median duration of symptoms prior to appendectomy compared to those who did not receive a pre-operative bath (29 hours vs. 24 hours; P = 0.042). The rate of same-day discharge was similar between the two cohorts (no CHG: 56.3% vs. CHG: 56.1%; P = 0.992). Neither cohort had a SSI recorded and there were no differences in frequencies of calls, unscheduled office visits or ER visits in the post-operative period. Conclusions-Implications. Our work suggests that pre-operative bathing with CHG prior to laparoscopic appendectomy for pediatric patients with uncomplicated appendicitis may not impact outcomes. Additional larger studies may be beneficial to make recommendations and guide the pre-operative care of these patients.