The burden of appendicitis and surgical site infection of appendectomy worldwide

Abstract

Introduction: Appendicitis is a global abdominal disease and is often treated by appendectomy. Surgical site infection (SSI) is a common complication after an appendectomy that causes a significant burden on health systems. This study aimed to evaluate the trends and variations in the burden of appendicitis by year, region, socioeconomic status, and health expenditure and to assess associated SSI by appendicitis burden, surgical approach, and type of appendicitis.

Methodology: Data on Disability-Adjusted Life Years (DALYs) and the human development index were collected from the Global Burden of Disease (GBD) Study and the United Nations Development Programme, respectively. Studies on SSI after appendectomy using the uniform definition and published in 1990-2021 were retrieved.

Results: Between 1990 and 2019, the global age-standardized DALY rate of appendicitis decreased by 53.14%, with the highest burdens in Latin America and Africa. The burden of appendicitis was significantly negatively correlated with HDI (r = -0.743, p<0.001) and health expenditure (r = -0.287, p<0.001). Among 320 published studies on SSI after an appendectomy, 78.44% of studies did not report criteria for SSI diagnosis or adopt a uniform definition. In total, 69 studies with uniform SSI definitions were included. Studies with uniform SSI definitions were recorded poorly in regions with a heavy burden of appendicitis. The SSI of appendectomy was positively correlated with open appendectomy and complicated appendicitis.

Conclusions: Uniform SSI definition, promotion of laparoscopic technology, and establishment of SSI special management are needed to decrease the burden of SSI after an appendectomy, especially in developing countries.