Peer Review Report For: Risk Factors for Surgical Site Infections after Paediatric Appendectomies in a Tertiary Care Teaching Hospital in Coastal Karnataka [version 1; peer review: 2 approved]

Introduction Surgical site infections (SSIs) occur in 1.3% to 4% of paediatric appendectomies. It is the most common complication after an appendectomy. Surgical complications in paediatric patients increase patient susceptibility to opportunistic infections, falls and drug-related side effects The aim of this study was to identify the modifiable risk factors for SSIs after paediatric appendectomies. Methodology Paediatric patients who underwent appendectomies from April 2018 to April 2023 in a tertiary care teaching hospital in coastal Karnataka were included. Clinical characteristics of patients were collected from the medical records of the patients. Results A total of 459 paediatric patients underwent appendectomies between 2018 and 2023. 45 (9.8%) developed surgical site infections (SSIs). Chi-squared tests (or Fisher’s exact tests, where appropriate) revealed significant associations (p < 0.05) between SSIs and the following categorical variables: faecal incontinence, surgical technique, wound type, type of appendicitis, postoperative stay and use of invasive devices. Multivariate logistic regression analysis further identified laparotomy (OR = 4.39, 95% CI: 1.31–14.74), presence of invasive devices (OR = 104.4, 95% CI: 5.45–2002.93), longer consultation-to-surgery time (OR = 1.48, 95% CI: 1.17–1.88), and increased surgery duration (OR = 1.02 per minute, 95% CI: 1.01–1.04) as independent risk factors significantly associated with the development of SSIs. Discussion The study identified laparotomy, use of drains, delayed surgery, and longer operation time as key risk factors for SSIs after paediatric appendectomies. Despite standard precautions, high SSI rates were observed, likely due to modifiable surgical factors and antimicrobial resistance. The findings highlight the need for optimized surgical practices, timely intervention, and multidisciplinary strategies to reduce SSI rates and improve patient outcomes.