Incidence and Risk Factors of Surgical Site Infections after Elective Gastrointestinal Surgery: A Prospective Cohort Study

Abstract

Introduction: Surgical Site Infection (SSI) is defined as an infection that occurs within an incisional wound within 30 days following the procedure. SSI continues to be a significant contributor to extended hospital stays and elevated morbidity, with significant mortality even with well-equipped operation theaters with modern sterilisation techniques, surgical equipment, proper antibiotic cover, and newer surgical methods. Proper identification of the risk factors and modification, if possible, is the only way to optimise surgical outcomes and reduce SSI. Aim: To assess the incidence of SSI and analyse the risk factors associated with SSI. Materials and Methods: A prospective cohort study was conducted from March 2020 to March 2022 at a rural medical college in the coastal area of Alappuzha district of Kerala, India. Patients over 18 years of age admitted for elective gastrointestinal (GI) surgery for various indications were included. Those presenting with pre-existing infections other than the indication for surgery and those undergoing laparoscopic surgeries were excluded. Operations were performed on the third day after admission for all patients. The incidence of SSI and its relation with age, gender, smoking, diabetes, preoperative serum albumin, White Blood Cell (WBC) count, type and duration of surgery, American Society of Anaesthesiologists (ASA) physical status, and surgical wound were analysed using the Chi-square test and Fisher’s exact test. Results: On analysis of 216 patients, variables such as smoking, diabetes, preoperative low serum albumin, higher ASA physical status, contaminated and dirty wound, and prolonged duration of surgery were strongly associated with the development of SSI. Conclusion: Patients with risk factors such as smoking, diabetes, preoperative low serum albumin, higher ASA physical status, contaminated and dirty wound, and prolonged duration of surgery should receive special attention to optimise surgical outcomes and mitigate the risk of infection.