Effect of abdominal drain on surgical site infection undergoing laparoscopic appendectomy for perforated appendicitis in adults: a propensity score matching analysis

To investigate the effect of abdominal drain on the incidence of surgical site infection undergoing laparoscopic appendectomy for perforated appendicitis in adults. Clinical data of adult patients who were intraoperatively diagnosed with perforated appendicitis and underwent laparoscopic appendectomy at the Affiliated Hospital of Qingdao University between January 2019 and December 2024 were retrospectively analyzed. According to whether an abdominal drain was placed during surgery, the patients were categorized into an abdominal drain group and a non-abdominal drain group. A total of 128 patients were included, comprising 73 cases in the abdominal drain group and 55 cases in the non-abdominal drain group. Baseline demographic and clinical characteristics were collected. Propensity score matching (PSM) was employed to balance intergroup differences in clinical features. After PSM, the baseline characteristics between the two groups showed no significant differences and were well-balanced (P > 0.05). The abdominal drain group exhibited significantly longer operative time (P = 0.010), duration of postoperative antibiotic use (P < 0.001), and length of stay (P < 0.001). Before matching, the overall surgical site infection (SSI) rates were 27% in the abdominal drain group and 23% in the non-abdominal drain group, with no statistically significant difference between the groups (P = 0.61). After matching, the overall SSI rate was 24% in both groups, and the difference remained statistically non-significant (P > 0.99). Our findings do not support routine abdominal drain placement in adults with perforated appendicitis undergoing laparoscopic appendectomy and align with current guideline trends. However, prospective multicenter randomized controlled trials are warranted.