Surgical site infections (SSIs) are among the most common postoperative complications encountered in clinical practice, accounting for nearly 20% of all healthcare-associated infections in surgical patients (1). These infections not only prolong hospital stays but also increase patient morbidity, healthcare costs, and, in severe cases, mortality (2,3). Laparotomy, a common surgical approach for various intra-abdominal pathologies, presents a significant risk for SSI, particularly in emergency settings due to suboptimal preparation and increased contamination (4,5).

The nature of the surgery—whether elective or emergency—is a critical factor influencing the risk of postoperative infections. Elective procedures are typically planned, allowing for better preoperative optimization, sterile conditions, and prophylactic measures (6). In contrast, emergency laparotomies are often performed under time constraints, with limited preoperative preparation and frequently in the presence of contamination, such as bowel perforation or peritonitis, thereby increasing the infection risk (7,8).

Multiple factors contribute to the development of SSIs, including the patient's nutritional status, comorbidities such as diabetes, duration of surgery, antimicrobial prophylaxis, and classification of surgical wounds (9,10). Despite advances in surgical techniques and infection control protocols, the burden of SSIs remains high, especially in resource-limited settings where emergency procedures constitute a significant portion of surgical workload (11,12).

Previous studies have documented higher SSI rates in emergency abdominal surgeries compared to elective procedures; however, there is a lack of region-specific data, particularly from tertiary care centers in developing countries (13,14). This study aims to evaluate and compare the incidence of SSIs following emergency and elective laparotomy, and to identify contributing risk factors in a tertiary care setup. The findings may provide insights for developing targeted strategies to minimize postoperative infections and enhance surgical outcomes.

A total of 120 patients who underwent laparotomy procedures during the study period were enrolled using purposive sampling. Patients were divided equally into two groups: 60 patients who underwent emergency laparotomy and 60 patients who underwent elective laparotomy. Inclusion criteria comprised patients aged ≥18 years who underwent midline laparotomy with either clean-contaminated, contaminated, or dirty wounds as per CDC classification. Exclusion criteria included patients with pre-existing infections at the surgical site, immunocompromised individuals (e.g., HIV-positive or on long-term corticosteroids), and those lost to follow-up before 30 days post-surgery.

Data Collection

Patient demographics (age, sex), comorbidities (diabetes mellitus, hypertension), smoking status, type and duration of surgery, wound classification, ASA score, and intraoperative findings were recorded using a structured proforma. All surgeries were conducted under standardized sterile protocols. Prophylactic antibiotics were administered preoperatively in all cases, according to hospital infection control guidelines.

Definition and Monitoring of SSI

Surgical site infections were defined based on the Centers for Disease Control and Prevention (CDC) criteria, which include superficial, deep, and organ-space infections occurring within 30 days postoperatively. Patients were evaluated daily during hospitalization and were followed up at outpatient visits on the 7th, 14th, and 30th postoperative days. Clinical examination and, where necessary, culture and sensitivity testing of wound discharge were conducted to confirm infection.

Statistical Analysis

Data were entered and analyzed using SPSS software version 25.0. Categorical variables were expressed as frequencies and percentages, while continuous variables were summarized as means and standard deviations. The chi-square test or Fisher’s exact test was used to analyze categorical variables, and the independent t-test was used for continuous variables. A p-value of less than 0.05 was considered statistically significant.

A total of 120 patients were included in the study, comprising 60 individuals each from the emergency and elective laparotomy groups. The mean age of the study population was 45.4 ± 13.6 years, with a male-to-female ratio of 1.3:1. Demographic and clinical characteristics are summarized in Table 1.

Table 1: Demographic and Clinical Characteristics of Study Participants

*Statistically significant(Table 1)

The overall incidence of surgical site infections (SSIs) in the study population was 35% (42/120). SSIs were observed in 28 patients (46.7%) in the emergency laparotomy group compared to 14 patients (23.3%) in the elective group, which was statistically significant (p = 0.004) (Table 2).

Table 2: Incidence of Surgical Site Infections in Both Groups

*Statistically significant(Table 2)

Among the types of SSIs, superficial infections were most common, accounting for 61.9% of cases, followed by deep and organ-space infections (Table 3).

Table 3: Distribution of Surgical Site Infection Types

(Table 3)

When stratified based on surgery duration, SSIs were more frequent in procedures exceeding two hours (58.1%) as compared to those under two hours (23.7%), which was statistically significant (p = 0.001) (Table 4).

Table 4: Association of Surgery Duration with SSI Rates

*Statistically significant (Table 4)

This study investigated and compared the incidence of surgical site infections (SSIs) in patients undergoing emergency versus elective laparotomy. Our findings demonstrate a significantly higher rate of SSIs among emergency laparotomy cases (46.7%) compared to elective procedures (23.3%), highlighting the influence of surgical urgency on postoperative infection risk.

The elevated incidence of SSIs in emergency surgeries may be attributed to several factors, including inadequate preoperative preparation, higher prevalence of contaminated or dirty wounds, and increased physiological stress in patients presenting acutely (1,2). Previous research has consistently shown that emergency procedures are associated with a higher risk of postoperative infections due to time constraints, delayed antibiotic administration, and suboptimal aseptic measures (3,4). Our results align with these observations and reaffirm the need for improved perioperative protocols, particularly in emergency settings.

The current study also found a significant association between the presence of comorbidities, especially diabetes mellitus, and the development of SSIs. Diabetes has long been recognized as a major risk factor for postoperative infections due to impaired wound healing and reduced immune response (5,6). Similar trends have been reported by other studies, which found that hyperglycemia adversely affects leukocyte function, thereby increasing the risk of infection (7,8).

Moreover, surgical duration exceeding two hours was another significant predictor of SSI in our study. Prolonged operative time increases tissue exposure to environmental pathogens, desiccation, and surgical trauma, all of which contribute to infection development (9). Studies have shown that every additional hour of surgery can increase the SSI risk by 1.3 times (10). Our data supported this relationship, as a larger proportion of SSIs occurred in surgeries lasting more than two hours.

The classification of surgical wounds also played a critical role. Contaminated and dirty wounds, more common in emergency settings, had a markedly higher association with SSIs than clean-contaminated wounds often seen in elective procedures (11). Prior investigations have highlighted the predictive value of wound class in infection surveillance and prevention programs (12,13).

Interestingly, the most prevalent type of SSI in this cohort was superficial infection, accounting for approximately 62% of all cases. This finding is consistent with earlier studies, which noted that superficial SSIs are the most common form but, if not promptly addressed, can progress to deeper infections or result in wound dehiscence (14,15).

While elective laparotomies showed significantly lower infection rates, SSIs were not entirely absent in this group. This suggests that even in controlled surgical environments, there is a need to optimize modifiable factors such as glycemic control, antibiotic timing, and intraoperative sterility to reduce infection risk further.

A limitation of our study is its cross-sectional design, which prevents the establishment of causal relationships. Additionally, microbiological confirmation was limited to cases presenting with discharge or clinical suspicion, which may have led to underreporting of subclinical SSIs. Nevertheless, the findings provide valuable insights for infection control in abdominal surgeries and emphasize the importance of targeted strategies, particularly in emergency surgical care.

This study highlights a significantly higher incidence of surgical site infections following emergency laparotomies compared to elective procedures. Key contributing factors include surgical urgency, presence of comorbidities, prolonged operative duration, and wound contamination. Strengthening infection control protocols, optimizing preoperative preparation, and timely antibiotic prophylaxis—especially in emergency settings—are crucial for minimizing SSI rates and improving patient outcomes.

1. Jatoliya H, Pipal RK, Pipal DK, Biswas P, Pipal VR, Yadav S, et al. Surgical Site Infections in Elective and Emergency Abdominal Surgeries: A Prospective Observational Study About Incidence, Risk Factors, Pathogens, and Antibiotic Sensitivity at a Government Tertiary Care Teaching Hospital in India. Cureus. 2023 Oct 31;15(10):e48071.
2. Alamrew K, Tadesse TA, Abiye AA, Shibeshi W. Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infections at Ethiopian Tertiary-Care Teaching Hospital. Infect Dis (Auckl). 2019 Nov 27;12:1178633719892267.
3. Mohan N, Gnanasekar D, Tk S, Ignatious A. Prevalence and Risk Factors of Surgical Site Infections in a Teaching Medical College in the Trichy District of India. Cureus. 2023 May 25;15(5):e39465.
4. Akhter MS, Verma R, Madhukar KP, Vaishampayan AR, Unadkat PC. Incidence of surgical site infection in postoperative patients at a tertiary care centre in India. J Wound Care. 2016 Apr;25(4):210-2, 214-7.
5. Sattar F, Sattar Z, Zaman M, Akbar S. Frequency of Post-operative Surgical Site Infections in a Tertiary Care Hospital in Abbottabad, Pakistan. Cureus. 2019 Mar 12;11(3):e4243.
6. Branch-Elliman W, Ripollone JE, O'Brien WJ, Itani KMF, Schweizer ML, Perencevich E, et al. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study. PLoS Med. 2017 Jul 10;14(7):e1002340.
7. Ekwunife OH, Coleman PS, Mabanza KT, Suleiman IE, Mulbah RG, Mohammed S, et al. Overview of Rate and Risk Factors of Surgical Site Infection in a Tertiary Hospital in Liberia: A Prospective Cohort Study. J West Afr Coll Surg. 2023 Oct-Dec;13(4):87-92.
8. Bykowski MR, Sivak WN, Cray J, Buterbaugh G, Imbriglia JE, Lee WP. Assessing the impact of antibiotic prophylaxis in outpatient elective hand surgery: a single-center, retrospective review of 8,850 cases. J Hand Surg Am. 2011 Nov;36(11):1741-7.
9. Shah S, Singhal T, Naik R, Thakkar P. Predominance of multidrug-resistant Gram-negative organisms as cause of surgical site infections at a private tertiary care hospital in Mumbai, India. Indian J Med Microbiol. 2020 Jul-Dec;38(3-4):344-50.
10. Dhamnaskar S, Mandal S, Koranne M, Patil P. Preoperative Surgical Site Hair Removal for Elective Abdominal Surgery: Does It Have Impact on Surgical Site Infection. Surg J (N Y). 2022 Aug 2;8(3):e179-e186.
11. Ratnesh K, Kumar P, Arya A. Incidence of Surgical Site Infections and Surgical Antimicrobial Prophylaxis in JNMC, Bhagalpur, India. J Pharm Bioallied Sci. 2022 Jul;14(Suppl 1):S868-S871.
12. Nguyen D, MacLeod WB, Phung DC, Cong QT, Nguy VH, Van Nguyen H, et al. Incidence and predictors of surgical-site infections in Vietnam. Infect Control Hosp Epidemiol. 2001 Aug;22(8):485-92.
13. Shah S, Singhal T, Naik R. A 4-year prospective study to determine the incidence and microbial etiology of surgical site infections at a private tertiary care hospital in Mumbai, India. Am J Infect Control. 2015 Jan;43(1):59-62.
14. Bekiari A, Pappas-Gogos G, Dimopoulos D, Priavali E, Gartzonika K, Glantzounis GK. Surgical site infection in a Greek general surgery department: who is at most risk? J Wound Care. 2021 Apr 2;30(4):268-274.
15. Mekhla, Borle FR. Determinants of superficial surgical site infections in abdominal surgeries at a Rural Teaching Hospital in Central India: A prospective study. J Family Med Prim Care. 2019 Jul;8(7):2258-63.