COMPARISON OF SURGICAL SITE INFECTION RATES BETWEEN EMERGENCY AND ELECTIVE APPENDECTOMY: A RETROSPECTIVE STUDY

Background: Surgical site infections (SSIs) are among the most common postoperative complications and significantly increase morbidity, length of stay, and healthcare costs. Appendectomy is frequently performed as an emergency procedure, and its infection risk may vary based on urgency and surgical approach. Aim: This study aimed to compare SSI rates between emergency and interval (elective) appendectomy and to identify independent risk factors for postoperative SSI. Methods: We conducted a retrospective cohort study of all appendectomy cases at King Hussein Medical Center between 2020 and 2023. Patients were categorized as emergency or interval appendectomy. Data on demographics, comorbidities, operative details, and postoperative outcomes were collected. SSI was defined per CDC criteria as any superficial, deep, or organ-space infection within 30 days. Group comparisons used Wilcoxon rank-sum and chi-squared tests, and multivariable logistic regression identified independent predictors of SSI. Results: Among all cases, laparoscopic surgery was more common in the interval group (90% vs. 74%), while open surgery was more frequent in emergencies (26% vs. 10%, p < 0.001). Emergency cases more often involved perforation (20% vs. 4.2%, p < 0.001) and had longer operative times (64 vs. 59 min, p < 0.001) and length of stay (3.4 vs. 2.7 days, p < 0.001). SSIs occurred predominantly after emergency appendectomy (86% vs. 67%, p < 0.001). Independent predictors of SSI included emergency presentation (OR 1.99, p = 0.021), open approach (OR 2.27, p < 0.001), perforation (OR 2.19, p = 0.003), diabetes (OR 2.67, p < 0.001), and longer operative time (OR 1.01 per minute, p = 0.036). Conclusion: Emergency appendectomy was associated with a significantly higher risk of SSI, especially with open surgery, perforation, diabetes, and prolonged operative duration. Targeted prevention and prioritization of laparoscopic techniques may reduce SSI risk.