Incidence and Risk Factors of Surgical Site Infections Following Clean-Contaminated Abdominal Surgeries: A Prospective Observational Cohort Study at a Tertiary Care Hospital
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Background: Surgical site infection remains a major cause of postoperative morbidity after abdominal surgery, particularly in tertiary-care settings where emergency presentation, wound contamination, prolonged operative duration, and inconsistent perioperative practices may increase infection risk. Objective: To determine the 30-day incidence, clinical pattern, and independent predictors of surgical site infection among adults undergoing abdominal surgery at a tertiary-care hospital in Multan, Pakistan. Methods: This prospective observational cohort study was conducted from 1 June 2023 to 31 May 2024 at Nishtar Hospital, Multan. Adult patients undergoing elective or emergency abdominal surgery with clean-contaminated or higher-contamination operative fields were followed until postoperative day 30. Surgical site infection was defined using CDC criteria. Patient-related, procedural, and perioperative variables were analyzed, and multivariable logistic regression was used to identify independent predictors. Results: Among 246 patients, 58 developed surgical site infection, giving a 30-day incidence of 23.6%. Superficial incisional infection was most common, accounting for 55.2% of cases, followed by deep incisional infection in 27.6% and organ-space infection in 17.2%. Independent predictors included open surgical approach (aOR 3.12, 95% CI 1.42–6.85), emergency surgery (aOR 2.82, 95% CI 1.53–5.19), ASA grade ≥III (aOR 2.34, 95% CI 1.18–4.63), inappropriate antibiotic timing (aOR 2.05, 95% CI 1.12–3.75), and operative duration >120 minutes (aOR 1.96, 95% CI 1.08–3.55). Mean hospital stay was longer among patients with surgical site infection than those without infection. Conclusion: Surgical site infection affected nearly one-quarter of abdominal surgery patients in this cohort. Emergency surgery, open approach, higher ASA grade, prolonged operative duration, and inappropriate antibiotic prophylaxis timing were key predictors, supporting targeted infection-prevention strategies and structured postoperative surveillance
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