Comparison of Gentamicin Saline Solution and Normal Saline in Reducing Surgical Site Infections in Open Appendectomy: A Randomized Controlled Trial

Surgical site infections (SSIs) are a significant source of morbidity and healthcare costs following open appendectomy, particularly in resource-limited settings. While wound irrigation with antimicrobial agents has shown potential in reducing SSI rates, evidence comparing gentamicin-saline solution with normal saline is limited. This study aimed to determine whether gentamicin-saline irrigation reduces SSI rates compared to normal saline alone and to identify patient-related risk factors associated with SSI development. This single-centre, single-blinded, randomized controlled trial included 190 patients undergoing uncomplicated emergency open appendectomy between June 2022 and June 2023. Patients were randomly assigned to two groups: one receiving 160 mg gentamicin in 400 mL normal saline for wound irrigation, and the other receiving normal saline alone. The primary outcome was the incidence of SSI within 30 days. Secondary outcomes included length of hospital stay and association of SSI with risk factors such as BMI, smoking, and alcohol use. Statistical analysis was performed using SPSS v.26. Group differences were assessed using independent t-tests and Fisher's exact or χ 2 tests as appropriate. A p value < 0.05 was considered statistically significant. Among 190 patients (95 per group), the overall SSI rate was 15.3%, all of which were superficial. The gentamicin group had a lower SSI rate (12.6%) compared to the saline group (17.9%), but the difference was not statistically significant (p = 0.313, RR 0.66; 95% CI, 0.298-1.478). Smoking was significantly associated with SSI occurrence (p = 0.039), while BMI showed a significant association only in the gentamicin group (p = 0.008). No association was observed with alcohol use. SSIs contribute substantially to patient complications and healthcare expenses, particularly in lower-resource surgical settings. The reduction in SSI incidence using gentamicin-saline was not statistically significant when compared with normal saline as compared to gentamicin-saline irrigation did not significantly reduce SSIs compared to saline alone in uncomplicated open appendectomy. Focus should be placed on modifiable patient-related risk factors, particularly smoking, to reduce SSI incidence in clinical practice.