Frequency and Factors of Post-Operative Surgical Site Infections in A Tertiary Care Hospital

Abstract

Background: Surgical site infections (SSI) are frequent, preventable postoperative complications that increase morbidity, prolong hospitalization, and raise healthcare costs, particularly in resource-limited settings. Objective: To determine the frequency and associated factors of clinically significant SSI among patients undergoing abdominal surgery at a tertiary care hospital. Methods: This prospective observational cohort study was conducted in the Department of General Surgery, Capital Hospital, Islamabad, from 26 November 2024 to 27 May 2025. Consecutive patients aged 13–75 years undergoing elective or emergency clean/clean-contaminated abdominal surgery were enrolled (n=344). SSI were defined using CDC/NHSN surveillance criteria within 30 days and graded by the Southampton wound grading system; clinically significant SSI were operationalized as Grades IV–V. Associations were assessed using chi-square tests and unadjusted odds ratios (OR) with 95% confidence intervals (CI); hospital stay was compared using an independent-samples t-test. Results: The mean age was 44.9 ± 9.0 years and 202 (58.7%) were male. Laparoscopic surgery was performed in 209 (61.0%) cases and 130 (37.8%) procedures were emergency. Overall, SSI occurred in 32 patients (9.3%). SSI was significantly associated with diabetes mellitus (OR 4.20, 95% CI 2.02–8.73), open surgery (OR 13.3, 95% CI 4.5–39.1), emergency procedures (OR 2.29, 95% CI 1.07–4.91), and operative duration ≥2 hours (OR 3.68, 95% CI 1.71–7.91). Staphylococcus aureus was the most common isolate (MSSA 25.0%, MRSA 18.8%). SSI patients had longer hospital stays (8.7 ± 2.7 vs 5.8 ± 1.8 days, p<0.001). Conclusion: Clinically significant SSI occurred in nearly one-tenth of abdominal surgeries and were strongly associated with diabetes, open approach, emergency surgery, and prolonged operative duration; infections were linked to substantially longer hospitalization, supporting targeted prevention strategies and broader adoption of minimally invasive surgery