A Comparative Study of the Incidence and Severity of Surgical Site Infection Following Emergency and Elective Abdominal Surgeries

BACKGROUND Surgical site infections (SSI) represent a significant hurdle in the recovery and return to normalcy of patients. When considering abdominal surgeries in particular, SSI and its complications have been identified as one of the most important causes for postoperative morbidity. Treatment of SSI’s ideally begins with prevention and this can be done with the identification of risk factors. This allows for appropriate stratification and institution of steps to safeguard the patient against the development of SSI in the pre-surgical period. The objectives of the study were to compare the incidence, severity and microbiological profile of surgical site infections following emergency and elective abdominal surgeries. METHODS This study was a prospective observational study, conducted from December 2017 to May 2019 at Father Muller Medical College Hospital, Mangalore, among patients who underwent laparotomy (regardless of indication) in either an elective or emergency setting. Patients who had SSI were then stratified using the ASEPSIS wound scoring system and the Southampton wound assessment scale. The type of SSI was further documented in each patient. Other parameters such as duration of stay in the hospital, microbiological profile, interventions performed etc. were also recorded in the study. RESULTS 150 patients were enrolled in the study (84 female and 66 male), 23 patients (incidence of 15.33 %) developed an SSI (7 elective cases and 16 emergency cases), whereas 127 did not. Of the organisms cultured, the most common was found to be coagulase negative staphylococcus (CoNS, 7 cases) followed by E. coli (4 cases). CONCLUSIONS The following factors were found to significantly contribute to the development of SSI - nature of the surgery, i.e. elective vs. emergency (P-value 0.040), class of wound (Pvalue 0.001), underlying malignancy (P-value 0.030) and a concomitant urinary tract infection (UTI) (P-value 0.045). The following factors were not found to contribute to the development of a SSI - sex of the patient (P-value 0.108), age of the patient (Pvalue 0.699), presence of diabetes mellitus (DM) (P-value 0.816), chronic kidney disease (CKD) (P-value 0.904) and acute respiratory infection (ARI) (P-value 0.909).