O3304: Intra-abdominal 0.05% Chlorhexidine Gluconate Lavage for Perforated Appendicitis

Background: 0.05% Chlorhexidine Gluconate (CHG) solution in sterile water was originally used for mechanical wound debridement and cleaning. The solution is increasingly used for intraoperative lavage in contaminated or dirty abdominal surgeries. At our institution, 0.05% CHG was adopted by pediatric surgeons in August 2021 and has been predominately used during appendectomy surgeries. The goal of this study is to determine the efficacy of intraoperative lavage with 0.05% CHG in preventing surgical site infection (SSI) after appendectomy for perforated appendicitis in the pediatric population.

Methods: The Electronic Medical Record was used to obtain data for patients aged < 18 years who underwent laparoscopic appendectomy for perforated appendicitis between January 2018 and February 2025 at our institution. Perforated appendicitis was defined as a visible hole in the appendix, a fecalith in the abdomen, purulent peritonitis, or intraabdominal abscess based on operative notes. Logistic regression was performed to generate propensity scores based on a patient’s likelihood of receiving 0.05% CHG lavage. Scores were then used for 1:1 matching between patients who did and did not receive intraoperative 0.05% CHG lavage to account for differences in patient characteristics (i.e. sex, race, age, payor group) and preoperative laboratory values (i.e. WBC, ANC, % Neutrophils, CRP). Postoperative outcomes, including organ-space SSI requiring drainage, superficial SSI, emergency department (ED) revisits, inpatient readmissions, and return to operating room (OR) rates, were compared between propensity-matched groups. Chi-square tests were performed to compare categorical variables and independent-samples t-tests were performed to compare means. A statistically significant difference was defined as p < 0.05.

Results: A total of 851 cases were identified. Of these cases, 0.05% CHG was used in 196 (23.0%). Following propensity-matching, there were no differences in sex, race, age, payor status, or laboratory values between groups (Table 1). Procedure duration was comparable between groups (Mean 53.6 minutes (SD 19.9) with 0.05% CHG versus 50.0 minutes (SD 19.7) without, p = 0.07) (Table 2). There was a significant decrease in rates of drainage procedures for organ-space SSI (5.1% with 0.05% CHG versus 11.7% without, p = 0.02). There were no statistically significant differences in rates of superficial SSI (3.1% with 0.05% CHG versus 5.6% without, p = 0.22), ED revisits (10.7% versus 11.7%, p = 0.75), inpatient readmissions (7.1% versus 4.1%, p = 0.19), or return to OR (2% versus 1%, p = 0.41).

Conclusion: 0.05% CHG lavage during laparoscopic appendectomy for perforated appendicitis is an easy, low-cost intervention that appears to be safe and may lower rates of organ-space SSI requiring drainage. Prospective studies such as a randomized control trial are needed to further evaluate these findings.