Surgical site infections (SSIs) are among the most frequent postoperative complications encountered in clinical practice, particularly following abdominal and gastrointestinal procedures. The Centers for Disease Control and Prevention (CDC) defines SSI as an infection occurring at or near the surgical incision within 30 days of the operation or within 90 days if a prosthetic material is implanted. SSIs significantly impact patient outcomes by increasing morbidity, prolonging hospital stay, delaying recovery, and escalating healthcare costs.

Gastrointestinal surgeries are inherently associated with a higher risk of infection due to factors such as bowel manipulation, contamination from enteric contents, and prolonged operative duration. Additionally, patient-related risk factors including age, nutritional status, diabetes mellitus, and immunosuppression further contribute to the development of SSIs. The type of surgical approach whether open or laparoscopic also plays a crucial role, with open surgeries generally associated with a higher infection rate.

Despite advances in perioperative care and infection control protocols, SSIs continue to pose a considerable challenge in surgical practice, especially in resource-limited settings. Early identification and management of SSIs are crucial to reducing associated morbidity and improving surgical outcomes.

This study was undertaken to determine the prevalence of SSIs in patients undergoing gastrointestinal surgeries and to assess the associated postoperative outcomes, including length of hospital stay, need for reoperation, and mortality. The findings aim to inform targeted preventive strategies and promote evidence-based surgical care.

Study Design and Setting:

This was a hospital-based cross-sectional study conducted at the Department of General Surgery, Government General Hospital, Anantapur, Andhra Pradesh, India. The study was carried out over a period of three months, from 20th February to May 2024.

Study Population:

The study included 100 patients who underwent elective or emergency gastrointestinal surgeries during the study period. Patients were selected irrespective of age and gender, provided they fulfilled the eligibility criteria.

Inclusion Criteria:

Patients undergoing gastrointestinal surgeries (both open and laparoscopic)

Age ≥18 years

Provided informed consent

Exclusion Criteria:

Patients with pre-existing infections at the surgical site

Patients who left against medical advice before the 30-day postoperative period

Re-operative cases for previous SSIs

Data Collection:

Data were collected using a structured proforma. Demographic details, comorbidities, type of surgery, duration of surgery, and use of prophylactic antibiotics were recorded. Patients were monitored postoperatively for the development of SSIs, which were diagnosed based on CDC (Centers for Disease Control and Prevention) criteria. SSIs were categorized into superficial incisional, deep incisional, and organ/space infections.

Outcome Measures:

Primary outcome was the prevalence of SSIs. Secondary outcomes included duration of hospital stay, requirement of reoperation, and postoperative mortality.

Statistical Analysis:

Data were entered in Microsoft Excel and analyzed using SPSS version 25. Descriptive statistics such as frequency and percentage were used for categorical variables, and mean ± standard deviation for continuous variables. The association between SSI and outcomes was assessed using the Chi-square test or Student's t-test. A p-value <0.05 was considered statistically significant.

Ethical Consideration:

Ethical clearance was obtained from the Institutional Ethics Committee. Informed consent was obtained from all participants prior to inclusion in the study.

A total of 100 patients who underwent gastrointestinal surgeries were enrolled in the study. The demographic profile is summarized in Table 1. The majority of patients were over 50 years of age (50%), followed by those aged 31–50 years (38%) and below 30 years (12%). There was a male predominance with 62% males and 38% females.

Table 1: Demographic Profile of Study Participants (n = 100)

The overall prevalence of postoperative surgical site infections (SSI) was found to be 18% (n = 18), while 82% (n = 82) of patients did not develop SSI (Table 2). Among the 18 SSI cases, superficial incisional infections were the most common (61.1%), followed by deep incisional (22.2%) and organ/space infections (16.7%).

Table 2: Prevalence and Characteristics of Surgical Site Infections (SSI)

A comparison based on surgical approach revealed that SSI was more prevalent in patients who underwent open surgeries (23.3%) as compared to those who had laparoscopic procedures (10%) (Table 3). This suggests a higher risk of infection associated with open surgical techniques.

Table 3: Distribution of SSI by Type of Surgery

The presence of SSI had a significant impact on postoperative outcomes. The mean hospital stay for patients with SSI was 14.6 ± 4.2 days, which was significantly longer than the 7.4 ± 2.5 days observed in those without SSI (p < 0.001). Additionally, two patients (11.1%) in the SSI group required reoperation, and one patient (5.6%) succumbed to sepsis-related complications. No such adverse outcomes were observed in the non-SSI group (Table 4).

Table 4: Outcomes of Patients with and without SSI

The present study found a surgical site infection (SSI) prevalence of 18% among patients undergoing gastrointestinal surgeries, with a significantly higher incidence in open surgeries compared to laparoscopic procedures. These findings are consistent with global trends reported in the GlobalSurg Collaborative study, which highlighted that SSI rates are considerably higher in low- and middle-income countries due to limited resources and inadequate infection control measures [7].

In our study, superficial incisional SSIs were the most common, aligning with the findings from Jimma Medical Center, Ethiopia, where superficial infections predominated and were strongly associated with poor wound care and prolonged preoperative hospital stay [8]. The prolonged mean hospital stay of 14.6 days among SSI patients in our study mirrors similar observations from large multicentric studies in China and Ethiopia, where infections led to delayed recovery, increased treatment burden, and additional hospital costs [8,9].

A national cross-sectional study from China also identified open surgical techniques, longer operative time, and contamination level of the surgical wound as significant risk factors for SSIs—factors that were also relevant in our cohort [9]. Furthermore, a recent study from Nigeria demonstrated that SSIs not only prolong hospital stay but also increase the likelihood of postoperative complications and mortality, findings that reinforce the clinical burden observed in our setting [10].

Studies from Cameroon and Vietnam emphasized the positive impact of robust infection control measures, including antibiotic stewardship and surgical safety protocols, in reducing SSI incidence [11,12]. This underlines the importance of structured perioperative care pathways and highlights the need to implement such measures consistently across resource-limited settings like ours.

This study highlights a significant prevalence of surgical site infections (SSIs) following gastrointestinal surgeries, with an overall rate of 18%. SSIs were more common in open surgeries compared to laparoscopic procedures, emphasizing the benefits of minimally invasive techniques. Superficial incisional infections were the most frequently observed type. The presence of SSI was associated with prolonged hospital stay, increased reoperation rates, and mortality. These findings underscore the importance of strict adherence to aseptic techniques, appropriate antibiotic prophylaxis, and early postoperative surveillance. Implementing infection control protocols and promoting laparoscopic approaches where feasible can substantially reduce the burden of SSIs and improve surgical outcomes.

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