Risk Factors and Independent Predictors of Surgical Site Infection Following Abdominal Surgery: A Prospective Observational Cohort Study

Kamal Bhushan Jain, Deepa Jain, Shubham Jain
Author(s)
1Assistant Professor, Department of Surgery, Ajay Sangal Institute of Medical Science and Ayushman Hospital, Jamalpur, Uttar Pradesh, India. 2Assistant Professor, Department of Obstetrics and Gynaecology, Ajay Sangal Institute of Medical Science and Ayushman Hospital, Jamalpur, Uttar Pradesh, India. 3Senior Resident, Department of Medicine, Ajay Sangal Institute of Medical Science and Ayushman Hospital, Jamalpur, Uttar Pradesh, India

Abstract

Background: A surgical site infection (SSI) is a frequent postoperative complication after abdominal operations. It leads to morbidity, to longer hospital stays or to higher health care costs. The aim of this study was to calculate the rate of SSI and establish independent predictors following abdominal surgery. Material and Methods: Prospective observational study of 300 adult patients with elective or emergency abdominal surgery was carried out at a tertiary care teaching hospital. Patients were followed up for 30 days post-surgery and SSI diagnosed following the Centers for Disease Control and Prevention (CDC) criteria. Univariable and multivariable logistic regression analyses were carried out to identify independent risk factors for SSI. Results: 46 patients out of 300 patients in the study developed SSI with an incidence rate of 15.3%. The most common subtype of SSI was superficial incisional (52.2%). Multivariable analysis identified advanced age (aOR 1.36, 95% CI 1.08–1.72), diabetes mellitus (aOR 2.44, 95% CI 1.25–4.76), obesity (aOR 2.16, 95% CI 1.09–4.30), hypoalbuminemia (aOR 2.58, 95% CI 1.28–5.20), ASA class III–IV (aOR 2.80, 95% CI 1.36–5.77), emergency surgery (aOR 2.27, 95% CI 1.19–4.35), operative duration ≥120 minutes (aOR 2.98, 95% CI 1.53–5.81), and contaminated/dirty wounds (aOR 2.36, 95% CI 1.19–4.67) as independent predictors of SSI (all p<0.05). Appropriate perioperative antimicrobial prophylaxis was found to significantly decrease the risk of SSI (aOR 0.44, 95% CI 0.21–0.93). The discrimination of the prediction model was excellent (AUC=0.862). Conclusion: SSI is still a relevant type of complication after abdominal surgery. Timely identification of high-risk patients, optimization of modifiable risk factors, and following evidence-based principles for perioperative infection prevention could spare people from postoperative SSIs and enhance surgical outcomes.

Keywords: Surgical site infection; Abdominal surgery; Risk factors; Predictors; Prospective study; Logistic regression.

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