Surgical Site Infections in Elective Abdominal Operations: Predisposing Factors. A Prospective Randomized Clinical Trial

Background Surgical site infection (SSI) is the third most common hospital-acquired infection (HAI). Specific patient characteristics and comorbidities appear to be independent prognostic factors for SSIs. In addition, operation and hospitalization characteristics affect the incidence of SSIs. Methods This prospective clinical study was conducted in the 1st Department of Surgery of the Sismanoglion General Hospital of Athens over a period of 7 years. Patients undergoing elective abdominal surgery received antimicrobial treatment as chemoprophylaxis. Monitoring of the patients was carried by multiple daily visits during their hospitalization and continued after they were discharged via phone until postoperative day 30. Results During the study period, 31 of the 715 patients undergoing elective abdominal surgery were diagnosed with SSI, giving an infection rate of 4.3%. The age of the patients with SSIs was significantly higher. Patients with certain comorbidities, including diabetes mellitus (DM), respiratory deficiency and heart failure (HF), a severity score on the American Society of Anesthesiologists (ASA) physical status classification system of ASA>3, and those with concomitant infections had a significantly increased risk of SSIs. SSIs were more common following open surgery than laparoscopic surgery, and surgery of the lower than the upper gastrointestinal (GI) tract, and postoperative hemorrhage increased the risk. Conclusion There is a paucity of studies assessing the relative contribution of the various predisposing factors to the incidence of SSIs. In our study, patients with DM, HF, respiratory deficiency, postoperative hemorrhage and concomitant infections, and patients undergoing lower GI tract operation appeared more prone to SSIs, presenting this complication 2 to 8 times more frequently. The risk of SSI following laparoscopic surgery was one quarter of that of open elective abdominal surgery. On the other hand, patients in this series with obesity, renal failure, steroid intake, radiation therapy, thyroid disease, stomas, previous surgery, intraperitoneal adhesions and inflammatory bowel disease did not develop SSIs more frequently.