What measures can improve surgical and patient safety for a patient with appendicitis and a history of asthma undergoing laparoscopic appendectomy?

Preoperative Antibiotics Are the Critical Safety Measure

For a patient with appendicitis and asthma undergoing laparoscopic appendectomy, preoperative antibiotics (Option B) are the most important safety measure that directly impacts morbidity and mortality. Site marking and equipment checks are standard surgical protocols but do not specifically address the infectious complications of appendicitis, and ignoring asthma history would be dangerous but is not a "safety improvement" option.

Why Preoperative Antibiotics Are Essential

A single preoperative dose of broad-spectrum antibiotics administered 0-60 minutes before surgical incision is strongly recommended for all patients undergoing appendectomy 1, 2. This practice directly reduces surgical site infections (SSI), which are a major source of postoperative morbidity 3.

• The evidence demonstrates that laparoscopic appendectomy already has lower SSI rates compared to open surgery, but preoperative antibiotics further reduce this risk 3, 4
• For uncomplicated appendicitis, a single preoperative dose is sufficient and postoperative antibiotics are not needed 2, 5
• For complicated appendicitis, antibiotics should continue postoperatively but not beyond 3-5 days with adequate source control 2

The Asthma History Cannot Be Ignored

The question's Option C (ignoring asthma) is medically inappropriate and would increase perioperative risk. Patients with asthma require:

• Preoperative optimization of bronchodilator therapy
• Careful anesthetic planning to avoid bronchospasm triggers
• Consideration that laparoscopic surgery may be particularly beneficial, as it causes less postoperative pain and allows earlier mobilization, reducing pulmonary complications 3

Laparoscopic appendectomy is specifically recommended for patients with comorbidities, as it offers advantages in high-risk patients 3.

Site Marking and Equipment Checks

While Option A represents good surgical practice, these are routine safety protocols for all surgeries and are not specific interventions that improve outcomes for appendicitis patients:

• Site marking is less relevant for laparoscopic appendectomy where the surgical field is standardized
• Equipment checks are standard operating room protocols that should occur regardless
• These measures prevent wrong-site surgery but do not address the specific risks of appendicitis (infection, perforation, abscess formation)

The Evidence Hierarchy

The 2020 World Journal of Emergency Surgery guidelines provide the strongest evidence 3, consistently emphasizing:

• Preoperative antibiotic administration as a core recommendation
• Laparoscopic approach as preferred for patients with comorbidities
• The importance of timely surgery (within 24 hours for uncomplicated cases) 1, 2, 5

Common Pitfalls to Avoid

• Never delay surgery to "optimize" asthma beyond ensuring adequate bronchodilator therapy - appendectomy should occur within 24 hours of admission 1, 2, 5
• Do not skip preoperative antibiotics - this single intervention significantly reduces SSI risk 1, 2
• Do not assume asthma is irrelevant - communicate with anesthesia about the patient's respiratory status and ensure appropriate perioperative management