Evaluation of patient related modifiable and non-modifiable risk factors in causation of surgical site infection in various abdominal surgeries

Abhinav Agrawal, Shivam Madeshiya, Roshni Khan, Shashank S. Tripathi, Gaurav Bharadwaj


Background: Surgical Site Infection (SSI) is second commonest nosocomial complication in surgical speciality. Majority of surgical wounds are contaminated by microbes, but in most cases, infection does not develop because innate host defense are quite efficient in elimination of contaminants. The objective of this study was to evaluate patient related risk factors in causation of surgical site infection in various abdominal surgeries.

Methods: All patients who admitted in surgical OPD/emergency and undergoing abdominal surgical procedures were included in study. This observational study was comprised of 952 subjects. Patients were observed in wards and during follow up to assess signs and symptoms of surgical site infection.

Results: Result were analysed in terms of age, sex, distribution of cases based on case scenario (elective v/s emergency), wound class, type of surgery (laparoscopic v/s open), smoking, diabetes, duration of surgery, complete hemogram before and after blood transfusion, number of blood transfusions, albumin, blood sugar level, discharge from surgical site, number of days of drains, stoma  and hospital stay.

Conclusions: Surgical site infection in emergency cases were found to be higher as compared to elective cases. Occurrence of SSI proportionately increased with degree of contamination, duration of surgery and age of patients. Laparoscopic procedures showed fewer incidences of surgical site infection as compared to open procedures. Various factors showed statistically significant association with surgical site infections were diabetes, smoking, blood transfusions, haemoglobin and albumin levels. Presence of stomas and drains were associated with increased incidence of SSI but could not be proven statistically.


Contaminants, Infection, Nosocomial, Surgical wounds

Full Text:



Cruse PJ, Foord R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60(1):27-40.

Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surg. 1961;50(1):161-8.

Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH. Antimicrobial prophylaxis for surgical wounds: guidelines for clinical care. Arch Surg. 1993;128(1):79-88.

Dahms RA, Johnson EM, Statz CL, Lee JT, Dunn DL and Beilman GJ. Third generation cephalosporin and vancomycin as risk factor for post-operative vancomycin resistant enterococcus infection. Arch Surg. 1998:1343-46.

Patel SM, Patel MH, Patel SD, Soni ST, Kinariwala DM, Vegad MM. Surgical site infections: Incidence and risk factors in a tertiary care hospital, Western India. Natl J Community Med. 2012;3:193-6.

Hernandez K, Ramos E, Seas C, Henostroza G, Gotuzzo E. Incidence of and risk factors for surgical-site infections in a Peruvian hospital. Infection Control Hosp Epidemiol. 2005;26:473-7.

Sørensen LT, Hemmingsen U, Kallehave F, Wille-Jørgensen P, Kjærgaard J, Møller LN, et al. Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg. 2005;241(4):654-58.

Haley RW, Hooton TM, Culver DH, Stanley RC, Emori TG, Hardison CD et al. Nosocomial infections in US hospitals, 1975-1976: estimated frequency by selected characteristics of patients. Am J Med. 1981;70(4):947-59.

Halkos ME. Reduced preoperative haemoglobin HbAiC level is associated with SSI and morbidity. Ann J. 2010;192(5):46-7.

Weber WP, Zwahlen M, Reck S, Misteli H, Rosenthal R, Buser AS, et al. The association of preoperative anemia and perioperative allogeneic blood transfusion with the risk of surgical site infection. Transfusion. 2009;49(9):1964-70.

Espandar R, Farhud AR, Yazdanian S. Hypoalbuminemia as a cause of post-surgical wound discharge after orthopaedic surgery. In Orthopaedic Proceedings. Brit Editorial Soc Bone Joint Surg. 2011;93:122-122.

Mawalla B, Mshana SE, Chalya PL, Imirzalioglu C, Mahalu W. Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania. BMC Surg. 2011;11(1):3-5.

Bucher BT, Guth RM, Elward AM, Hamilton NA, Dillon PA, Warner BW, et al. Risk factors and outcomes of surgical site infection in children. J Am Coll Surg. 2011;212:1033-8.

Chu DI, Schlieve CR, Colibaseanu DT, Simpson PJ, Wagie AE, Cima RR, et al. Surgical site infections (SSIs) after stoma reversal (SR): risk factors, implications, and protective strategies. Journal of Gastrointestinal Surgery. 2015 Feb 1;19(2):327-34.

Suh YJ, Jeong SY, Park KJ, Park JG, Kang SB, Kim DW, et al. Comparison of surgical-site infection between open and laparoscopic appendectomy. J Korean Surg Soc. 2012. Jan;82(1):35-9.