Surgical Site Infection: Incidence, Risk Factors, and Outcomes in Gynaecological Surgeries

Abstract

Background: Surgical-site infection (SSI) is a significant postoperative complication for gynaecological surgery, and can result in delayed wound healing, need for readmission and further surgery, and longer hospitalisation. The risk factors that can be modified must be identified in order to improve perioperative care and minimize postoperative morbidity..

Objective: To determine the incidence, associated risk factors and postoperative outcomes of surgical-site infection among patients undergoing gynaecological surgery.

Material and Methods: This multicentre prospective observational study was conducted at Qazi Hussain Ahmad Medical Complex, Nowshera, and Timergara Medical College/DHQ Teaching Hospital, Timergara, from January 2023 to June 2023. The women were sampled consecutively for a total of 72 women undergoing elective or emergency surgery in the gynaecology ward. Demographic, clinical and operative data was collected. Surgical site infection was observed for 30 days after surgery and while in hospital. Patients infected and non-infected were compared and a binary logistic regression analysis was performed to determine variables independent to the infection. Statistically significant was defined as a p value of < 0.05.

Results: Surgical-site infection developed in 11 of 72 patients, giving an incidence of 15.3%. Superficial incisional infection was the most frequent type, occurring in 7 (63.6%) infected patients, followed by deep incisional infection in 3 (27.3%) and organ-space infection in 1 (9.1%). Diabetes mellitus, obesity, anaemia, emergency surgery, operative duration exceeding 120 minutes, blood loss greater than 500 mL, perioperative transfusion and inappropriate antibiotic prophylaxis were significantly associated with infection. Patients with surgical-site infection had a longer mean hospital stay than those without infection, 9.7 ± 3.8 versus 4.6 ± 2.1 days, respectively (p < 0.001). They also had higher rates of readmission, wound dehiscence, sepsis and reoperation.

Conclusion: Surgical-site infection affected approximately one in seven patients undergoing gynaecological surgery and was associated with important patient-related and operative risk factors. Preoperative optimisation of diabetes, obesity and anaemia, timely antibiotic prophylaxis, careful haemostasis and reduction of prolonged operative time may decrease infection-related morbidity.

Keywords: Surgical-site infection; gynaecological surgery; risk factors; hysterectomy; postoperative complications; wound infection.