Effect of Plastic Bag Extraction in Minimally Invasive Appendectomy.

BACKGROUND: Evidence regarding the effects of plastic bag use for appendix removal during minimally invasive appendectomy remains scarce and conflicting. OBJECTIVE: This study aimed to analyze the effects of plastic bag use during minimally invasive appendectomy on preoperative infection risk, morbidity and mortality. DESIGN: This retrospective analysis of the prospective National Surgical Quality Improvement Program (NSQIP) cohort program. SETTING: This study included data from the NSQIP database between the years of 2016 and 2019. PATIENT: Adult patients undergoing minimally invasive (laparoscopic or robotic) without unplanned conversion to open surgery. INTERVENTION: Use of plastic bag for specimen removal during appendectomy. MAIN OUTCOME MEASURES: Risk ratios for the incidence of superficial surgical site infection, intra-abdominal abscess, overall medical morbidity, and overall mortality. RESULTS: There were 43 783 cases of minimally invasive appendectomy in the NSQIP database between the years of 2016 and 2019. Among those who reported information regarding use of plastic bag, 28 589 (91.87%) reported use of plastic bag for specimen removal. Use of plastic bag was associated with a significant decrease in superficial surgical site infection (RR .39 (95% CI: .31-.49), P < .001), and in the risk of postoperative intra-abdominal abscess (RR: 0.66 (.57-.77), P < .001)). We also observed a robust reduction in overall medical-related morbidity and overall mortality, even after adjusting for multiple confounders. LIMITATIONS: Observational nature of the study cannot exclude residual bias. Also, there was a significant rate of missing values for plastic bag use, which may bias results. CONCLUSIONS: In this global prospective cohort using NSQIP database, use of plastic bag for appendix removal during minimally invasive appendectomy was associated with a significant improvement in surgical related outcomes and reduction in morbidity and overall mortality.