Predictors of Surgical Site Infection Following Emergency Laparotomy: A Retrospective Cohort Study at Ayub Teaching Hospital

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.