Wound management in perforated appendicitis

Open wound management after perforated appendicitis was common practice but , recently, primary closure has been advocated to reduce costs and morbidit y. Hospital records from 319 adults who underwent appendectomy from 1993 to 1996 were reviewed to identify surgical wound infections (SWIs) and examin e risk factors. Information about age, length of stay (LOS), operative time , white blood cell count, and antibiotic administration were obtained. Perf oration was either noted at operation or identified microscopically by the pathologist. If primary wound closure was performed, patients with acute ap pendicitis and perforation had a 4-fold higher readmission rate, a 5-fold i ncrease in SWI, and twice the LOS compared with patients with acute appendi citis without perforation. Patients with grossly perforated acute appendici tis had no difference in LOS if the wound was treated open or closed primar ily. No patient with microscopic perforation and primary wound closure deve loped SWI. Primary wound closure after acute appendicitis was safe in the a bsence of clinical perforation. In the presence of clinical appendiceal per foration the wound should be left open.