Impact of intraoperative hemostatic material placement on intra-abdominal infection control in acute appendicitis: a retrospective cohort study

OBJECTIVE: To evaluate the impact of sodium carboxymethyl cellulose (SCMC)-based absorbable hemostatic gauze on postoperative infectious outcomes in emergency laparoscopic appendectomy (LA) for acute appendicitis. METHODS: A retrospective analysis of 184 patients undergoing emergency LA at General Surgery Department of Beijing Fengtai You'anmen Hospital (Collaborative Hospital of Peking University First Hospital Medical Alliance) from January 2024 to March 2025 was conducted. All consecutive patients were included without selection based on disease severity. Patients were divided into two groups: SCMC gauze placement group (n = 55) and non-gauze group (n = 129). Perioperative parameters were compared between groups using descriptive statistics and simple group comparisons (t-test, Mann-Whitney U test, χ² test). RESULTS: Baseline characteristics were well balanced between groups (P > 0.05 for all). No surgical site infections (SSI) or intra-abdominal abscesses were observed in either group during the three-month follow-up period. Key outcomes showed no statistically significant differences (P > 0.05), including: positive rate of intra-abdominal pus culture (97.8% overall); detailed microbial species distribution (e.g., Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus spp.); inflammatory markers (WBC, CRP, PCT at 24 h/72 h postoperatively); peak WBC and time to peak; peak body temperature and time to peak; and length of stay (LOS). The distribution of disease severity by AAST CT grade was similar between groups, with no significant difference (P = 0.740). All procedures were completed laparoscopically with zero mortality. CONCLUSION: The rational use of SCMC-based absorbable hemostatic gauze during emergency LA appears safe, with no observed association between intraoperative gauze placement and increased postoperative infection risk. Given the non-randomized design and zero event rate, these findings should be interpreted as an observational safety signal, not equivalence or antimicrobial benefit.