Routine Placement of Prophylactic Drain Versus Non-Use of Drain in Patients Undergoing Emergency Open Appendectomy for Complicated Appendicitis at a Tertiary Referral Hospital in Botswana: A Randomized Controlled Trial

Abstract To evaluate the efficacy of the transperitoneal drains in reducing the onset of the postoperative intra-abdominal abscess and surgical-site infection (SSI) following emergency open appendectomy for complicated appendicitis. The study assessed whether utilization of drain was associated with adverse outcomes leading to prolonged hospital stay and increased healthcare expenditure. This was a prospective randomized controlled trial conducted at the Nyangabgwe Referral Hospital, carried out from December 2022 to September 2023. The study included all patients aged 16-years-old and over, with complicated appendicitis, and who underwent emergency open appendectomy. Patients with uncomplicated appendicitis and those scheduled for laparoscopic appendectomy were excluded. Altogether, 263 participants were consented for the trial, of whom 128 were randomized into the drainage (DG), and 135 into the non-drainage (NDG) groups. A total of 118 patients (44.87%) developed postoperative SSI (DG: 81.35%; NDG: 18.64%; p = 0.001). The length of hospital stay (LOS) was found to be longer in patients with transperitoneal drains than those without (DG: 6 days; NDG: 4 days; p = 0.001). There were three patients (1.14%) who underwent relook laparotomies, two from the DG and one from the NDG (p = 0.304). There was no risk of postoperative intra-abdominal abscess formation between patients belonging to the DG (N = 128) and those in the NDG (N = 135; p < 0.0001). Overall, no mortality was registered in both study groups. Routine placement of prophylactic transperitoneal drain in patients with complicated appendicitis who undergo emergency open appendectomy shows no statistical improvement over non-usage and, generally, does not avert the onset of postoperative SSI, ileus, or fecal fistula. Moreover, drain usage was linked to prolonged length of hospital stay and increased total healthcare expenditure.