Effects of oxygen concentration and active warming on surgical site infections in pediatric appendectomy: A prospective randomized study
Ahmet Baş1
, Çiğdem Ulukaya Durakbaşa2, Selma Fettahoğlu Üstel3, Zeynep Nur Orhon4
1Department of Pediatric Surgery, Health Sciences University Başakşehir Çam ve Sakura City Hospital, İstanbul, Türkiye
2Department of Pediatric Surgery, Medeniyet University Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Türkiye
3Department of Pediatric Surgery, Health Sciences University Bakırköy Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
4Department of Anesthesiology and Reanimation, Medeniyet University Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Türkiye
Keywords: Appendicitis, hypothermia, oxygen, surgical site infection.
Abstract
Objectives: We aimed to evaluate the potential effects of postoperative active warming and oxygen support on the incidence of surgical site infections (SSIs) in pediatric patients who underwent surgery for acute appendicitis.
Patients and methods: Between March 2011 and September 2011, a total of 80 pediatric patients (49 males, 31 females; mean age: 129.63 ± 44.39 months; range: 39 to 220 months) who underwent surgery for acute appendicitis were prospectively enrolled in this randomized clinical study. Patients were sequentially allocated into four groups according to perioperative oxygen concentration and postoperative thermal bed use. All patients were warmed with a thermal bed during the operation. Group A (n = 22) received 40% oxygen without thermal bed support; Group B (n = 18) received 40% oxygen with postoperative thermal bed application; Group C (n = 20) received 100% oxygen without thermal bed support; and Group D (n = 20) received 100% oxygen with postoperative thermal bed application. Each group was planned to include 22 patients, and sequential randomization was used to ensure balanced group allocation.
Results: Among the pediatric patients included in the study, acute non-complicated appendicitis was the most common diagnosis (63.8%). No statistically significant difference was observed among groups regarding age (p = 0.497), sex (p = 0.093), or diagnosis (p = 0.340). Surgical site infection occurred in 13.8% of patients, significantly more in Groups A (31.8%) and C (20.0%) (p = 0.005). No differences were observed in infection type (p = 0.545) or culture positivity (p = 0.120). Fever ≥ 37.5°C within 48 h postoperatively was present in all patients with SSI (100%) and in 56.5% without SSI, showing a strong association (p = 0.006). The mean number of febrile days was higher in infected patients (10.73 vs. 7.31, p = 0.153). Abdominal ultrasonography in deep SSI cases (n = 3) showed only fascia inflammation. No free fluid or abscess in the abdomen.
Conclusion: Active warming significantly reduced the incidence of SSIs in pediatric appendectomy patients, regardless of perioperative oxygen concentration.
Citation:
Baş A, Ulukaya Durakbaşa Ç, Fettahoğlu Üstel S, Orhon ZN. Effects of oxygen concentration and active warming on surgical site infections in pediatric appendectomy: A prospective randomized study. Turkish J Ped Surg 2026;40(1):32-39. https://doi.org/10.62114/JTAPS.2026.189.