European Journal of Cardiovascular Medicine

Surgical site infections (SSIs) are one of the most frequent postoperative complications and remain a significant contributor to morbidity, prolonged hospital stay, and healthcare costs worldwide. They represent nearly 20% of healthcare-associated infections and are considered a key indicator of quality in surgical care [1,2]. The burden is particularly high in abdominal surgeries, where contamination from the gastrointestinal tract, longer operative times, and complex wound management increase vulnerability to infection [3].

The etiology of SSI is multifactorial, with contributions from both patient-related factors (such as advanced age, diabetes mellitus, obesity, malnutrition, and smoking) and surgery-related variables (including emergency procedures, contaminated wounds, prolonged operative duration, use of drains, and inappropriate prophylactic antibiotic timing) [4,5]. Although infection-control measures and antibiotic prophylaxis have significantly reduced the rates in high-income countries, the incidence remains comparatively higher in low- and middle-income regions due to resource constraints and overcrowded surgical units [6].

In India, reported SSI rates range between 10% and 30% depending on surgical type, hospital setting, and patient profile [7,8]. Abdominal surgeries, being among the most commonly performed major procedures, are particularly prone to infectious complications, yet hospital-based data on incidence and risk determinants remain limited.

Recognizing the incidence and identifying risk factors are vital to implementing targeted preventive strategies. With this background, the present hospital-based study was designed to evaluate the incidence of SSIs in abdominal surgeries and to analyze the associated patient- and surgery-related risk factors contributing to their occurrence.

Study Design and Setting:
This was a prospective observational hospital-based study conducted in the Department of General Surgery at Dr. YSR Government Medical College, Pulivendula, over a period of four months from 20 September 2023 to 20 January 2024.

Study Population:
All patients undergoing abdominal surgeries during the study period were considered eligible. Both elective and emergency procedures were included.

Inclusion Criteria:

• Patients of all age groups and both sexes undergoing abdominal surgeries (elective or emergency).
• Patients who provided informed consent to participate in the study.

Exclusion Criteria:

• Patients with pre-existing infections at the surgical site.
• Patients lost to follow-up within the postoperative observation period.
• Patients undergoing minor procedures not requiring admission.

Sample Size:
A total of 100 patients were enrolled using consecutive sampling.

Data Collection:
Demographic details, clinical history, comorbid conditions (such as diabetes, obesity, smoking), and perioperative details (type of surgery, emergency vs. elective, wound classification, duration of surgery, use of drains, timing of prophylactic antibiotics) were recorded using a structured proforma.

Definition of SSI:
SSIs were identified and classified according to the Centers for Disease Control and Prevention (CDC) criteria into superficial incisional, deep incisional, and organ/space infections. Patients were followed up for 30 days postoperatively, either during admission or through outpatient visits, for detection of SSI.

Statistical Analysis:
Data were entered into Microsoft Excel and analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were expressed as frequencies and percentages. The Chi-square test was applied to identify associations between risk factors and SSI. A p-value <0.05 was considered statistically significant.

Out of 100 patients undergoing abdominal surgeries, surgical site infections (SSIs) were observed in 18 cases, yielding an overall incidence of 18% (Table 1).

Table 1. Incidence of Surgical Site Infections (SSI)

Incidence of SSI: 18% among abdominal surgeries.

Figure 1. Incidence of Surgical Site Infections(SSI)

When stratified by type, superficial incisional SSI constituted the majority (55.6%), followed by deep incisional SSI (27.8%) and organ/space infections (16.6%) (Table 2).

Table 2. Distribution of SSIs by Type

Observation: Superficial infections were the most common.

Figure 2. Distribution of SSIs by Type

Analysis of patient-related factors revealed that advancing age (>50 years) was significantly associated with SSI (66.7% vs. 34.1%; p=0.01). Similarly, diabetes mellitus (38.9% vs. 12.2%; p=0.01) and obesity (33.3% vs. 14.6%; p=0.04) were significant risk factors. Male sex and smoking history showed a higher proportion among infected cases, but these differences were not statistically significant (Table 3).

Table 3. Patient-Related Risk Factors for SSI

*Statistically significant

Figure 3. Patient-Related Risk Factors for SSI

With respect to surgery-related factors, emergency procedures (50.0% vs. 18.3%; p=0.004), prolonged operative time >2 hours (72.2% vs. 25.6%; p<0.001), and contaminated/dirty wounds (55.6% vs. 17.1%; p=0.002) were strongly associated with SSI occurrence. Additionally, the use of drains (44.4% vs. 20.7%; p=0.03) and delay in administration of prophylactic antibiotics beyond 60 minutes (33.3% vs. 12.2%; p=0.02) were significant contributors (Table 4)

Table 4. Surgery-Related Risk Factors for SSI

*Statistically significant

In the present hospital-based study, the overall incidence of surgical site infection (SSI) following abdominal surgeries was 18%, which is consistent with reports from other Indian centers, where SSI rates range between 10% and 25% depending on hospital infrastructure, patient profile, and infection-control measures [1–3]. Internationally, the incidence is lower, generally between 2% and 10% in high-income countries, reflecting the impact of stringent perioperative protocols and advanced surgical facilities [4].

Superficial incisional SSI was the most common type (55.6%), followed by deep incisional and organ/space infections. This distribution parallels previous studies, where superficial infections constituted the majority due to greater exposure to skin commensals and wound handling [5]. The lower proportion of deep and organ-space infections in our cohort may be attributed to prompt diagnosis and adequate antibiotic prophylaxis.

Among patient-related risk factors, age above 50 years, diabetes mellitus, and obesity were significantly associated with SSI. These findings are biologically plausible, as advancing age is linked with impaired immune response, diabetes compromises wound healing through microvascular changes and hyperglycemia, while obesity increases tissue handling difficulty and reduces vascularity [6,7]. Smoking history and male sex showed higher proportions among infected cases but did not reach statistical significance, similar to observations in some Indian studies [8].

Surgery-related determinants played a major role in SSI development. Emergency procedures, prolonged operative duration (>2 hours), contaminated wounds, drain usage, and delay in prophylactic antibiotic administration were significant predictors. These observations align with studies from tertiary centers, where emergency surgeries inherently carry higher risk due to limited preoperative optimization, longer operative times increase tissue trauma, and wound contamination predisposes to bacterial colonization [9,10]. Inadequate timing of prophylactic antibiotics has also been repeatedly emphasized as a modifiable risk factor [11].

The findings of this study underscore the importance of a multifactorial approach to SSI prevention. Optimization of modifiable patient factors (glycemic control, weight reduction, smoking cessation), adherence to antibiotic timing protocols, and minimizing unnecessary drains could substantially reduce SSI burden. Given that SSIs significantly prolong hospital stay and increase healthcare costs, preventive strategies should be prioritized in surgical practice, particularly in resource-limited settings like ours.

Strengths and Limitations:
The strength of this study lies in its prospective design and adherence to CDC criteria for SSI diagnosis. However, the relatively small sample size and single-center design may limit generalizability. Long-term follow-up beyond 30 days, particularly for organ-space infections, was not performed.

Implications for Practice:
Our findings highlight the need for rigorous infection-control measures, judicious antibiotic prophylaxis, and continuous surgical team training. Developing hospital-based SSI surveillance systems could 

This hospital-based study demonstrated an overall incidence of 18% surgical site infections (SSI) following abdominal surgeries, with superficial infections being most frequent. Significant patient-related predictors included advanced age, diabetes mellitus, and obesity, while key surgical factors were emergency procedures, prolonged operative time, contaminated wounds, drain use, and delayed antibiotic prophylaxis. These findings emphasize the multifactorial nature of SSI and highlight both patient optimization and strict perioperative protocols as crucial preventive measures. Strengthening infection-control bundles, ensuring timely antibiotic administration, and minimizing modifiable risks can substantially reduce SSI burden, improve postoperative outcomes, and lower healthcare costs in resource-constrained surgical settings

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