PREDICTORS OF SURGICAL SITE INFECTION FOLLOWING EMERGENCY LAPAROTOMY: A RETROSPECTIVE COHORT STUDY AT AYUB TEACHING HOSPITAL
DOI:
https://doi.org/10.71000/y4qsnh84Keywords:
Albumins, Emergency Treatment, Laparotomy, Risk Factors, Smoking, Surgical Wound Infection, Wound HealingAbstract
Background: Surgical site infections (SSIs) remain one of the most common and preventable postoperative complications, particularly following emergency laparotomy performed under suboptimal conditions. Limited resources, delayed presentation, and high contamination rates contribute to increased infection risk in low- and middle-income countries. Understanding the magnitude and determinants of SSIs in such settings is essential for guiding targeted preventive strategies and improving surgical outcomes.
Objective: To determine the frequency, pattern, and independent risk factors associated with surgical site infections among patients undergoing emergency midline laparotomy at a tertiary care hospital.
Methods: A retrospective observational study was conducted at the Department of General Surgery, Ayub Teaching Hospital, Abbottabad, including 300 adult patients who underwent emergency midline exploratory laparotomy between January and December 2024. Patient demographics, comorbidities, operative parameters, and laboratory findings were extracted from hospital records. SSIs were identified and classified according to CDC/NHSN criteria within 30 days postoperatively. Data were analyzed using SPSS Version 26. Continuous variables were expressed as mean ± SD, and categorical data as frequencies and percentages. Univariate analysis employed chi-square and t-tests, while multivariable logistic regression determined independent predictors, reporting odds ratios (ORs) with 95% confidence intervals (CIs).
Results: The mean age was 48.0 ± 18.4 years, with males comprising 62.3% of patients. The overall SSI incidence was 28.7% (86/300), including 65% superficial, 29% deep, and 5% organ/space infections. Univariate analysis identified smoking (41.9% vs. 27.1%, p = 0.019), hypoalbuminemia (22.1% vs. 11.2%, p = 0.024), higher ASA grade (30.2% vs. 17.8%, p = 0.034), and contaminated/dirty wounds (61.6% vs. 48.1%, p = 0.05) as significant factors. Logistic regression confirmed smoking (OR = 2.01, 95% CI: 1.17–3.46, p = 0.012) and hypoalbuminemia (OR = 2.30, 95% CI: 1.17–4.56, p = 0.016) as independent predictors.
Conclusion: Surgical site infections represent a major postoperative complication after emergency laparotomy. Smoking and malnutrition significantly increase infection risk but remain modifiable through targeted preoperative counseling, nutritional support, and strict adherence to perioperative care bundles. Strengthening institutional infection prevention protocols may markedly improve surgical outcomes in resource-limited healthcare settings.
References
Shao H, Wang X, Feng L. Construction and validation of nomogram to predict surgical site infection after hysterectomy: a retrospective study. Sci Rep. 2024;14(1):20538.
Utsumi M, Yamada T, Yamabe K, Katsura Y, Fukuchi N, Fukunaga H, et al. Differences in risk factors for surgical site infection between laparotomy and laparoscopy in gastrointestinal surgery. PLoS One. 2022;17(9):e0274887.
Yamamichi T, Yoshida M, Sakai T, Takayama K, Uga N, Umeda S, et al. Factors associated with neonatal surgical site infection after abdominal surgery. Pediatr Surg Int. 2022;38(2):317-23.
Tropeano G, Chiarello MM, Fico V, Brisinda G. How to identify early complications in patients undergoing distal gastrectomy? World J Gastrointest Surg. 2024;16(4):974-81.
Zhang X, Yang Y, Liu P, Wang P, Li X, Zhu J, et al. Identification of Risk Factors and Phenotypes of Surgical Site Infection in Patients After Abdominal Surgery. Ann Surg. 2023;278(5):e988-e94.
Dodwad SM, Mueck KM, Kregel HR, Guy-Frank CJ, Isbell KD, Klugh JM, et al. Impact of Intra-Operative Shock and Resuscitation on Surgical Site Infections After Trauma Laparotomy. Surg Infect (Larchmt). 2024;25(1):19-25.
Maki H, Kim BJ, Kawaguchi Y, Fernandez-Placencia R, Haddad A, Panettieri E, et al. Incidence of and Risk Factors for Incisional Hernia After Hepatectomy for Colorectal Liver Metastases. J Gastrointest Surg. 2023;27(11):2388-95.
Zwicky SN, Gloor S, Tschan F, Candinas D, Demartines N, Weber M, et al. No impact of sex on surgical site infections in abdominal surgery: a multi-center study. Langenbecks Arch Surg. 2022;407(8):3763-9.
Srinivas S, Coleman JR, Baselice H, Scarlet S, Tracy BM. Open or Closed? Management of Skin Incisions After Emergency General Surgery Laparotomies. J Surg Res. 2024;304:190-5.
Shimane T, Koike K, Fujita S, Kurita H, Isomura ET, Chikazu D, et al. Positive impact of perioperative oral management on the risk of surgical site infections after abdominal surgery: Sixteen universities in Japan. Medicine (Baltimore). 2023;102(37):e35066.
Hanna K, Asmar S, Ditillo M, Chehab M, Khurrum M, Bible L, et al. Readmission With Major Abdominal Complications After Penetrating Abdominal Trauma. J Surg Res. 2021;257:69-78.
Mehdorn M, Kolbe-Busch S, Lippmann N, Moulla Y, Scheuermann U, Jansen-Winkeln B, et al. Rectal colonization is predictive for surgical site infections with multidrug-resistant bacteria in abdominal surgery. Langenbecks Arch Surg. 2023;408(1):230.
Bozzay JD, Walker PF, Schechtman DW, Shaikh F, Stewart L, Carson ML, et al. Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties. J Trauma Acute Care Surg. 2021;91(2S Suppl 2):S247-s55.
Ojewuyi OO, Ojewuyi AR, Fasanu AO, Asafa OQ, Taiwo OA, Folami EO. Surgical site infections following abdominal surgery: incidence, risk factors and outcomes. Afr Health Sci. 2024;24(4):91-8.
Saleem AF, Halepota HF, Omar H, Zain A, Mateen Khan MA. Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan. J Pak Med Assoc. 2020;70(12(a)):2244-6.
Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) Patient Safety Component Manual: Surgical Site Infection Event [Internet]. Atlanta: CDC; 2021.
Ahmad M, Khan M, Khan M, Aslam S, Nawaz M. Prevalence and Risk Factors of Surgical Site Infections in a Pakistani Tertiary Hospital. Pak J Med Sci. 2022;38(2):432–7.
Qamar A, Khan A, Ahmed N, Farooq M. Surgical Site Infection: A Review of Its Etiology and Prevention. J Pak Med Assoc. 2021;71(5):1623–7.
Garale MN, Sawant RS, Shah AS, Jadhav AS. Study of Surgical Site Infections Following Emergency Laparotomy. Int J Surg. 2020;7(2):104–9.
Ansari R, Noor S, Bano S, Ali Z. Predictors of Surgical Site Infection in Emergency Abdominal Surgeries. J Ziauddin Univ. 2021;13(1):23–7.
Shah M, Khan S, Aslam S. Surgical site infections: risk factors and preventive strategies. Pak J Surg. 2020;36(3):157–62.
National Institute for Health and Care Excellence (NICE). Surgical Site Infections: Prevention and Treatment. London: NICE; 2020.
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Copyright (c) 2025 Bahri Room, Omar Khan, Muhammad Umar Khan Ghauri, Muhammad Tayyab Khan, Sabahat Rashid Qureshi , Musa Afridi, Amir Sohail (Author)
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