Surgical Site Infection in Elective General Surgical Procedures

Wasim Hayat Khan, Ammara Zia-ul-Mustafa, Muhammad Haris Janjua, Noor Hajrah, Sharjeel Mahmood, Fatima Qureshi

Abstract

Objective

To determine the frequency of surgical site infection (SSI) and identify the associated risk factors in elective clean and clean-contaminated general surgical procedures.

Study design

This was a retrospective cohort study.

Place & Duration of study

Department of General Surgery, East Surgical Ward, Mayo Hospital Lahore, from January 2024 to January 2025.

Methods

The data of all patients aged >12 years who were operated electively under clean and clean-contaminated category of surgical procedures, were included.  All patients had standardized perioperative management according to institutional elective surgery and surgical site infection prevention protocols. Risk factor analysis was restricted to patients who completed 30 days and 90 days (in case of implant) follow-up. Data on demographics, comorbid conditions, category of wound, and outcomes were collected. SSI was defined according to CDC/NHSN criteria. Statistical analysis was performed using SPSS version 26.0 and R software. Continuous variables were compared using Student’s t-test and categorical variables using Chi-square or Fisher’s exact test. Multivariable analysis was performed using Firth bias-reduced logistic regression. A p-value <0.05 was considered significant.

Results

A total of 620 cases were identified; Among patients with completed follow-up (n = 397), SSI occurred in 53 (13.4%) patients. Superficial incisional SSI was the most common subtype (64.2%). The difference in length of hospital stay between SSI and non-SSI groups was not statistically significant (p=0.23). Approximately one-third of SSI cases required readmission. On multivariable Firth regression, none of the examined patient-level variables (age, sex, diabetes mellitus, obesity, smoking, or wound class) demonstrated an independent association with SSI.

Conclusion

The frequency of SSI in elective clean and clean-contaminated surgery remained substantial in our setting. The absence of independent patient-level predictors suggests that operating theatre environment and perioperative factors may play an important role and warrant further investigation.

Key words

Surgical site infection, Elective surgery, Clean wound, Clean contaminated wound.