European Journal of Cardiovascular Medicine

Surgical site infections (SSIs), which are among the most common healthcare-associated illnesses, make postoperative morbidity, longer hospital stays, and greater healthcare costs much worse. Even though there have been improvements in gynecology-specific surgical procedures, aseptic standards, and perioperative antibiotic prophylaxis, surgical site infections (SSIs) are still a problem in the field as a whole [1, 2]. In less developed countries, where hospitals may not have enough staff and patients may be more likely to get infections and other consequences, surgical site infections (SSIs) are a very severe problem [3].

Hysterectomy has become one of the most popular major gynecological surgeries performed worldwide due to its many uses for both benign and malignant conditions. Laparoscopic hysterectomy has become more popular as minimally invasive procedures have become more common. Some of its benefits over open abdominal hysterectomy are less stress on the tissue, fewer cuts, less pain after surgery, a shorter hospital stay, and a faster recovery. Even though laparoscopic techniques have cut down on surgical site infections (SSIs), they still happen to some people. It is crucial to remember this [4-6].

Age, obesity, diabetes mellitus, and nutritional condition are patient-related factors that elevate the incidence of surgical site infections (SSIs) subsequent to laparoscopic hysterectomy. Procedural variables, including duration of operation, intraoperative blood loss, surgical technique, and compliance with infection control procedures, are also significant factors. Microbiological factors and patterns of antibiotic resistance also have a big impact on how bad these diseases are and how they turn out. It is vital to identify SSIs promptly and administer adequate treatment to prevent complications such as wound dehiscence, severe infections, and sepsis [7, 8].

There is a deficiency of prospective data concerning the incidence, etiology, and microbiological profile of surgical site infections (SSIs) following laparoscopic hysterectomy, particularly within clinical environments in India. To find people who are at high danger and come up with good ways to keep them safe, you need to know these things very well. Consequently, the objective of this prospective study was to examine surgical site infections (SSIs) subsequent to laparoscopic hysterectomy, identify the microorganisms accountable for these infections, ascertain the prevalence of these infections, and evaluate the impact of SSIs on postoperative outcomes [9, 10].

This This prospective observational study was executed in the Department of Obstetrics and Gynecology at a tertiary care teaching hospital for a duration of 12 months. This study was conducted at the Department of Gynecology, Surabhi institute of Medical sciences, Siddipet, Telangana, India from the April 2021 To March 2022. The Institutional Ethics Committee approved the study procedure, and all subjects provided signed informed consent before enrollment. The study comprised 50 women who were having elective laparoscopic hysterectomy for non-cancerous gynecological problems. Data Collection: Age, BMI, socioeconomic level, and concomitant diseases like hypertension and diabetes mellitus were collected as baseline demographic data. Documentation included the following aspects of the operation: the reason for the surgery, the type of laparoscopic hysterectomy performed, the length of the procedure, the anticipated blood loss, and the use of antibiotics prior to and during the operation. Every day while in the hospital and at follow-up appointments, patients had their wounds evaluated for surgical site infections (SSIs) using established criteria. Inclusion Criteria: • Women aged ≥18 years undergoing elective laparoscopic hysterectomy • Patients operated for benign gynecological indications • Patients willing to provide informed consent and comply with follow-up • Patients available for postoperative follow-up for at least 30 days Exclusion Criteria: • Patients undergoing open abdominal or vaginal hysterectomy • Hysterectomy performed for malignant gynecological conditions • Patients with evidence of active infection at the time of surgery • Immunocompromised patients. • Patients lost to follow-up within 30 days postoperatively Statistical Analysis: Microsoft Excel was used for data entry, and SPSS, or the Statistical Package for the Social Sciences, was used for analysis. Mean ± standard deviation was used to represent continuous variables, whilst frequencies and percentages were used to portray categorical variables. When looking for a correlation between possible risk factors and surgical site infections, we used the independent t-test for continuous variables and the Chi-square test or Fisher's exact test for categorical ones. For statistical purposes, a p-value below 0.05 was deemed significant.

A total of 50 women who underwent elective laparoscopic hysterectomy were included in the final analysis and followed up for 30 days postoperatively for the development of surgical site infections (SSIs).

Table 1. Socio-demographic and Clinical Characteristics of the Study Population

The mean age of the study participants was 47.6 ± 7.2 years. Most patients were in the 41–50 years age group (40%). Obesity (BMI ≥30 kg/m²) was observed in 22% of patients. Diabetes mellitus and hypertension were present in 30% and 36% of patients, respectively.

Table 2. Operative Characteristics of Patients Undergoing Laparoscopic Hysterectomy

Fibroid uterus was the most common indication for surgery (48%). Total laparoscopic hysterectomy (TLH) was performed in 64% of cases. Nearly 44% of surgeries lasted more than 120 minutes, and 32% of patients had blood loss ≥200 mL.

Table 3. Incidence and Type of Surgical Site Infections

Surgical site infections were observed in 6 patients, giving an overall SSI incidence of 12%. Superficial incisional SSI was the most common type (8%), followed by deep incisional SSI (4%). No organ/space infections were reported.

Table 4. Association of Risk Factors with Surgical Site Infections

A statistically significant association was found between SSI occurrence and age >50 years, obesity, diabetes mellitus, and prolonged duration of surgery (>120 minutes). Patients with these risk factors showed a higher incidence of postoperative infections (p < 0.05).

Table 5. Microbiological Profile and Postoperative Outcomes in SSI Cases

Staphylococcus aureus was the most commonly isolated organism in SSI cases, followed by Escherichia coli. Patients who developed SSIs had a significantly prolonged postoperative hospital stay compared to those without infection. One patient required surgical wound drainage in addition to antibiotic therapy.

Even though minimally invasive surgical procedures have become the norm, surgical site infections (SSIs) are still a major risk for patients after surgery. Infections do still happen with laparoscopic hysterectomy, which adds to patient morbidity and more healthcare utilization, even if the incidence of SSIs is often lower than with open abdominal operations. Fifty patients who had laparoscopic hysterectomy were part of the prospective study that looked at the frequency, causes, and microbiological characteristics of surgical site infections (SSIs) [11-13].

The most prevalent kind of SSIs in this study were superficial incisional infections, which accounted for 12% of all cases. Consistent with earlier research, this finding shows that superficial wound infections at port locations are still a problem, even if laparoscopic hysterectomy lowers the risk of deep and organ/space infections. In this study, no organ or space SSIs were found, which shows that laparoscopic surgery is quite safe for treating deep pelvic infections [14-16].

The occurrence of SSIs was discovered to be substantially correlated with advancing age. A greater infection rate was observed in patients older than 50 years. This could be because of a combination of factors, including a natural decrease in immune function with age, the presence of several comorbidities, and a lag in wound healing. The importance of meticulous perioperative monitoring in older patients having gynecological surgeries has been highlighted by previous research that found similar results [17, 18].

The development of SSI was found to be significantly impacted by obesity. There was a statistically significant increase in the infection rate among patients whose body mass index was 30 kg/m² or higher. Wound contamination and impaired healing may be more likely in obese people due to increased adipose tissue, lower tissue perfusion, and technical difficulties during surgery. This discovery highlights the significance of counseling patients before surgery and optimizing their weight wherever possible [19].

The current study also found that diabetes mellitus was a significant predictor of SSIs. As a result of impaired leukocyte activity and collagen production, infection susceptibility is increased in individuals with poor glycemic control. This study's finding that diabetic individuals had a greater frequency of SSIs highlights the significance of closely monitoring and controlling blood glucose levels before surgery in order to lessen the risk of complications after surgery [20, 21].

SSI occurrence was also significantly impacted by characteristics linked to procedures. The infection rate was found to be considerably higher in operations that lasted longer than 120 minutes. The likelihood of tissue exposure, contamination, and operative stress all rise with surgical time, which in turn increases the likelihood of infection. Thus, strategies that attempt to decrease SSIs by making surgeries more efficient and taking less time during operations may be effective [22].

Staphylococcus aureus and gram-negative bacilli like Escherichia coli were the most often detected organisms in microbiological analyses. The usual skin and endogenous flora that cause gynecological infections after surgery match this microbial pattern. In order to guide proper empirical antibiotic therapy, it is vital to know the local microbiological profiles [23].

A longer postoperative hospital stay was related with surgical site infections (SSIs) compared to patients without infections, demonstrating the financial and medical burden of these consequences. The seriousness of these infections was highlighted by the fact that one patient needed surgical intervention, even though most SSIs were treated conservatively with medicines and wound care [24].

The results may not be applicable to a broader population due to the study's single-center design and limited sample size. Also, things like antibiotic resistance patterns and perioperative glucose levels weren't looked at thoroughly. The results are more convincing because of the systematic follow-up and prospective design of the study, which mitigate these limitations [25].

Despite the benefits of minimally invasive surgery, the current prospective investigation found 12% operative site infections after laparoscopic hysterectomy. The paucity of organ or space SSIs and most superficial incisional infections show how safe laparoscopic surgery is. Age, obesity, diabetes, and long-term surgery increase surgical site infection risk. These findings emphasize the importance of preoperative evaluation, co-morbidity management, and perioperative infection prevention. Early detection and treatment of SSIs reduces surgical morbidity and hospital stays. Rigid surgical technique, antibiotic prophylaxis, improved postoperative surveillance, and careful patient selection can reduce surgical site infections after laparoscopic hysterectomy. Multicentric studies are needed to validate these findings and create SSI prevention guidelines for minimally invasive gynecological surgery. Funding None Conflict of Interest: None

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