Incidence And Risk Factors For Surgical Site Infection Following Laparotomy At A South African Quaternary Hospital

Abstract

Background: A published report of surgical site infection (SSI) incidence and risk factors following laparotomy in a South African (SA) setting is lacking. This information would have important implications for SSI clinical prediction rules in SA patients undergoing this common surgical procedure. This study sought to determine the incidence and associated risk factors for SSI following laparotomy in a SA setting. Methods: This was a retrospective chart review study of 439 patients who underwent laparotomy at a SA quaternary hospital over a 5-year period. Demographic information, comorbidities, medication use, and surgery-related variables were collected for each patient. The Centers for Disease Control definition of SSI was used in this study. The incidence of SSI was determined using conventional epidemiological methods. Logistic regression was used to identify risk factors for SSI. Results: The incidence of SSI was 16.6% (CI: 13.4-20.4%). Risk factors for SSI included infectious indication for surgery (Odds Ratio, OR: 3.32, CI: 1.16-9.47; p=0.003), preoperative non-steroidal anti-inflammatory use (OR: 2.82, CI: 1.33-5.95; p=0.007), preoperative hypoalbuminemia (OR: 2.47, CI: 1.12-5.42; p=0.025), Bogota bag use (OR: 2.23, CI: 1.05-4.74; p=0.036), and perioperative blood transfusion (OR: 2.51, CI: 1.33-4.75; p=0.004). Conclusion: The incidence of SSI in SA patients undergoing laparotomy is higher than that reported for mixed surgical populations. Several risk factors for SSI were identified. The prognostic relevance of these risk factors, and the reduction in SSI risk when these factors are addressed requires further investigation.