Postoperative Surgical Site Infection (SSI) Rates After Elective Vs Emergency Laparotomy: An Audit

Shamail  Zahra; Hira  Waris; Bilal Irshad  Khan; Muhammad Hassan  Zafar; Hamza  Shahram; Muhammad Hammad  Shafiq

doi:10.54112/bcsrj.v6i8.1957

Authors

Shamail Zahra Department of Plastic Surgery, Holy Family Hospital, Rawalpindi, Pakistan
Hira Waris Department of General Surgery, Holy Family Hospital, Rawalpindi, Pakistan
Bilal Irshad Khan Department of General Surgery, Holy Family Hospital, Rawalpindi, Pakistan
Muhammad Hassan Zafar Department of Trauma and Orthopedics, Benazir Hospital, Rawalpindi, Pakistan
Hamza Shahram Department of General Surgery, Holy Family Hospital, Rawalpindi, Pakistan
Muhammad Hammad Shafiq Department of General Surgery, Holy Family Hospital, Rawalpindi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i8.1957

Keywords:

Surgical Wound Infection, Laparotomy, Elective Surgical Procedures, Emergency Treatment, Infection Control, Postoperative Complications

Abstract

Surgical site infections (SSIs) remain a significant postoperative complication following laparotomy, contributing to increased morbidity, prolonged hospital stays, and healthcare costs. Emergency laparotomies carry a higher SSI risk compared to elective procedures due to factors such as increased contamination, higher patient acuity, and complex surgical conditions. Objective: To audit and compare SSI rates in elective versus emergency laparotomy before and after implementing a structured SSI prevention bundle in a tertiary care hospital in Pakistan. Methods: This audit was conducted over two consecutive six-month periods, one before and one after implementing a WHO- and NICE-based SSI prevention bundle. Adult patients (≥18 years) undergoing elective or emergency laparotomy were included. Laparoscopic procedures, minor abdominal surgeries, and incomplete records were excluded from the analysis. The prevention bundle included timely prophylactic antibiotics, alcohol-based chlorhexidine skin preparation, intraoperative normothermia, perioperative glycaemic control, and standardized wound care. SSIs were diagnosed per CDC/NHSN definitions. Comparative analysis of pre- and post-intervention SSI rates was performed, with results expressed as percentages. Results: A total of 700 patients were included (350 per cycle), comprising 200 elective and 150 emergency laparotomies in each period. Elective SSI rates reduced from 3.5% to 2.5%, while emergency SSI rates fell more markedly from 12.0% to 7.3% after the intervention. Overall, SSI incidence declined from 7.1% pre-intervention to 4.6% post-intervention. The reduction was more pronounced in emergency cases, indicating a higher baseline risk and a greater benefit from the intervention. Conclusion: The implementation of a structured SSI prevention bundle resulted in a significant reduction in postoperative infection rates for both elective and emergency laparotomies, with the most notable improvement observed in high-risk emergency cases. These findings support the routine use of evidence-based perioperative infection prevention measures to improve surgical outcomes, particularly in resource-limited settings.

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References

Mirani S., Khan A., & Nsar A. Deep surgical site infections (dssis). The Professional Medical Journal 2019;26(03). https://doi.org/10.29309/tpmj/2019.26.03.3258

El-Din M... Laparoscopy versus laparotomy in the surgical treatment of perforated duodenal ulcers. The Egyptian Journal of Hospital Medicine 2020; 81(6):2173-2178. https://doi.org/10.21608/ejhm.2020.127963

Akter D., Bahar D., Islam D., Baishnab A., Quadir M., Haque M.et al.. Incidence of surgical site infections after emergency laparotomy for perforated peritonitis. International Journal of Surgery Science 2021; 5(2):335-338. https://doi.org/10.33545/surgery.2021.v5.i2f.718

Wasil A., Bakri S., Wisnu Y., & Mughni A. Comparison between laparotomy and laparoscopy colorectal cancer for length of hospital stay, surgical site infection, and intraperitoneal adhesion. Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal) 2020; 9(6):483-488. https://doi.org/10.14710/dmj.v9i6.29335

Oishi T., Nakamura F., Okuno N., Tamagaki K., Nakamura Y., Sakuramoto K.et al.. Effect of closed negative pressure wound therapy after laparotomy for gastrointestinal perforation: a single‐center observational study. Acute Medicine & Surgery 2025; 12(1). https://doi.org/10.1002/ams2.70069

Mahmood A., Ahmad A., Muzaffar M., & Ahmad S... Prevalence of wound infection in patients undergoing elective or emergency abdominal surgery. PJMHS 2021; 15(7):1697-1699. https://doi.org/10.53350/pjmhs211571697

Muhamad D., Manikam N., & Syaiful R... Association preoperative protein adequacy and post-elective laparotomy surgical site infection. Korean Journal of Gastroenterology 2023; 82(6):282-287. https://doi.org/10.4166/kjg.2023.103

Teppa R., Sude N., Karanam V., & Mallipudi B... Relevance of subcutaneous fat thickness as a risk factor for surgical site infections in abdominal surgeries. Cureus 2022. https://doi.org/10.7759/cureus.20946

Horasanlı J., EREN G., & İyisoy M... Comparison of laparoscopy and laparotomy results for benign ovarian tumors. Journal of Contemporary Medicine 2022; 12(6):997-1001. https://doi.org/10.16899/jcm.1123262

Emeka C. Childhood intussusception: correlation between ultrasound reports and intra-operative findings. Proceedings of Singapore Healthcare 2021; 31. https://doi.org/10.1177/20101058211010824

Amone D., Okello T., Okot C., Kitara D., Mugabi P., & Ogwang D.. Short-term outcomes of laparotomy in the two teaching hospitals of Gulu University, Northern Uganda. Archives of Clinical Gastroenterology 2020:069-076. https://doi.org/10.17352/2455-2283.000084

Dugad D., Mohanty D., Mahobia H., & Saha A... A comparative study of subcutaneous negative pressure versus simple closure of skin incision following surgery for hollow viscus perforation. International Journal of Surgery Science 2021; 5(2):269-271. https://doi.org/10.33545/surgery.2021.v5.i2e.706

Temesgen F., Gosaye A., Starr N., Kiflu W., Getachew H., Dejene B.et al.. Early outcome of laparotomy wounds in pediatric patients in Tash, Addis Ababa, Ethiopia: a six-month prospective study. Ethiopian Journal of Health Sciences 2021; 31(1). https://doi.org/10.4314/ejhs.v31i1.13

Tagar E., Kpolugbo J., Dongo A., Osime C., Irekpita E., & Irabor D. Abdominal wound closure in the presence of sepsis: our experience with the use of subcutaneous drain. Ghana Medical Journal, 2024; 58(1): 26-33. https://doi.org/10.4314/gmj.v58i1.5

Lee Y., Jeong S., Kim J., Yeo K., Kwon O., Kim K.et al.. Emergency department laparotomy for patients with severe abdominal trauma: a retrospective study at a single regional trauma center in Korea. Journal of Trauma and Injury 2024; 37(1):20-27. https://doi.org/10.20408/jti.2023.0072

Aghdassi S., Schröder C., & Gastmeier P... Gender-Related Risk Factors for Surgical Site Infections: Results from 10 Years of Surveillance in Germany. Antimicrobial Resistance and Infection Control 2019; 8(1). https://doi.org/10.1186/s13756-019-0547-x

Alkaaki A., Al‐Radi O., Khoja A., Alnawawi A., Alnawawi A., Maghrabi A.et al.. Surgical site infection following abdominal surgery: a prospective cohort study. Canadian Journal of Surgery 2019; 62(2):111-117. https://doi.org/10.1503/cjs.004818

Mukagendaneza M., Munyaneza E., Muhawenayo E., Nyirasebura D., Abahuje E., Nyirigira J.et al.. Incidence, root causes, and outcomes of surgical site infections in a tertiary care hospital in Rwanda: a prospective observational cohort study. Patient Safety in Surgery 2019; 13(1). https://doi.org/10.1186/s13037-019-0190-8

Ganesh V., Jayaraman R., Vignesh T., & Priya C... Prospective study on the incidence of surgical site infections in patients undergoing major abdominal surgeries in our hospital. International Journal of Surgery Science 2022; 6(1):79-82. https://doi.org/10.33545/surgery.2022.v6.i1b.824

Anjum R., Huda F., Goswami A., & Tandon A. Effect of personal protective equipment (PPE) on surgical site infection in emergency laparotomy: an observational study from a tertiary care centre. Cureus 2022. https://doi.org/10.7759/cureus.24278

Phelan L., Dilworth M., Bhangu A., Limbrick J., King S., Bowley D.et al.. Evaluation of a bundle of care to reduce incisional surgical site infection after gastrointestinal surgery. Journal of Infection Prevention 2019; 21(2):52-59. https://doi.org/10.1177/1757177419892072

Boland P., Kelly M., Donlon N., Bolger J., Mehigan B., McCormick P.et al.. Prophylactic negative pressure wound therapy for closed laparotomy wounds: a systematic review and meta-analysis of randomised controlled trials. Irish Journal of Medical Science (1971 -) 2020;190(1):261-267. https://doi.org/10.1007/s11845-020-02283-7

Al‐Sawat A., Mun J., Yoon S., & Lee C. Wound irrigation using wet gauze may reduce surgical site infection following laparoscopic appendectomy. Frontiers in Surgery 2022;9. https://doi.org/10.3389/fsurg.2022.813738

Sahebally S., McKevitt K., Stephens I., Fitzpatrick F., Deasy J., Burke J.et al.. Negative pressure wound therapy for closed laparotomy incisions in general and colorectal surgery. Jama Surgery 2018;153(11):e183467. https://doi.org/10.1001/jamasurg.2018.3467