Surgical site infections in the COVID-19 era: a comparative cohort study

Abstract

Background. The COVID-19 pandemic has put an important strain on the healthcare system all over the world. Several strategies to mitigate its impact have been proposed, with the sole purpose to prioritize the finite resources in different healthcare settings, in order to still provide qualitative medical services. As a result, elective surgeries, even for oncologic patients, were postponed or even cancelled, if the patient’s healthcare safety could not be maintained. Surgical site infections (SSIs), as defined by the Centers for Disease Control and Prevention (CDC), are a well-known cause of patient morbidity and of increased healthcare costs. Objectives. To assess the rate and impact of SSIs during the COVID-19 pandemic (the year 2020) compared to the rate during 2019 and to identify the prevention bundle to reduce their incidence in an important academic tertiary center in Romania. Materials and method. We performed a cohort study on operated patients in both obstetrics and gynecology departments, in a third-level maternity unit, the “Filantropia” Clinical Hospital of Obstetrics and Gynecology, Bucharest, regarding the prevalence of surgical site infections during one year of COVID-19 pandemic (2020) versus the prevalence and impact of the previous year (2019). This is an observational cohort retrospective study, analyzing the period from the 1st of January 2019 to the 31st of December 2019 and from the 1st of January 2020 to the 31st of December 2020, with the aim to evaluate the influence of highly surveillance and perioperative guidelines followed during the COVID-19 pandemic and to compare it to the regulations and guidelines followed during 2019. Results. Taking into account both gynecological interventions and caesarean sections, 6998 interventions were performed (3641 in 2019 and 3357 in 2020), with no significant difference regarding patients’ demographics. The number of operations performed were different, with fewer caesarean sections in 2020 (2061) compared to 2273 in 2019. Also, fewer operations for malignancies such as ovarian or endometrial cancers and laparoscopic procedures were performed in 2020 compared to 2019, due to difficulties in maintaining the patients’ and medical personnel safety. No significant difference rates were observed regarding postoperative complications or the length of stay. However, the total SSI complication rate was reduced in 2020 (1.22%) compared to the previous year (1.92%) due to the introduction of higher surveillance protocols and to medical personnel theoretical and hands-on education. Discussion. Risk factors, such as high Body Mass Index, increased blood glucose levels, smoking status, immunodeficiency or MRSA status, have an important role in facilitating the SSIs. Considering the epidemiological context, a reduced referral to medical services during pandemic, excluding emergencies, led to fewer surgeries performed in the gynecology department, fewer caesarean sections and to a total SSI rate decreased compared to 2019. Thus, understanding the multiple factors involved in the pathology, the importance of a responsible care and the existence of a record of these cases may help diminish the rate, especially during pandemic. Conclusions. Beside challenges faced during the pandemic period, we continued to perform surgical procedures with timely planning and meticulous care, keeping a low rate of SSIs (1.22%). The use of standardized protocols and a bundle of preventive strategies may be of great help in the better control of this type of infections.