Cutting the Risk: Surgical Site Infection Predictors in Major Abdominal Surgery

Abstract

 

Surgical site infections (SSI) remain among the most costly and preventable postoperative complications. This prospective cohort study evaluated predictors of SSI following major elective abdominal surgery. Between 2022 and 2024, 782 patients undergoing colorectal, hepatobiliary, or complex gastrointestinal surgery were followed for 30 days. SSI was defined using standardized criteria and categorized as superficial, deep, or organ-space.

Overall SSI incidence was 11.6% (n=91), with organ-space infections accounting for 34.1% of SSIs. Independent predictors included operative time >180 minutes (aOR 2.4; 95% CI 1.5–3.9; p<0.001), perioperative hypothermia (<36°C) (aOR 1.8; p=0.01), and diabetes mellitus (aOR 1.9; p=0.006). Appropriate prophylactic antibiotics within 60 minutes before incision reduced SSI risk by 29.3% (p=0.02), while postoperative glycemic control (mean glucose <180 mg/dL in first 48h) was associated with lower SSI rates (8.7% vs 14.9%; p=0.01). A risk stratification model using five variables (operative time, wound class, diabetes, hypothermia, transfusion) showed AUC 0.82, sensitivity 76.4%, specificity 74.1%.

These results support targeted perioperative bundles focusing on timing of prophylaxis, temperature maintenance, and strict glucose control to reduce SSI rates in high-risk abdominal surgery populations.