Prevalence and Profile of Early Surgical Site Infections Following Elective Neurosurgery and Laparotomy: An Observational Study

Abstract

Background:

Surgical site infections (SSIs) are among the most common healthcare-associated infections, contributing to significant morbidity and prolonged hospital stays. This study aimed to determine the prevalence and risk factors associated with early SSIs in patients undergoing elective neurosurgery and laparotomy at a tertiary care center in central India.

Material and Methods:

This prospective observational study was conducted over one year, including 721 patients who underwent elective neurosurgical or laparotomy procedures. Data on demographics, comorbidities, type of surgery, antibiotic prophylaxis timing, and surgical duration were collected. SSIs were identified using CDC/NHSN criteria, and microbiological evaluation was performed for infected cases.

Results:

The overall prevalence of SSIs was 15.53%, with higher incidence among patients aged 21–60 years and males. Diabetes mellitus was the most common comorbidity in SSI patients. SSIs were more frequent in laparotomy cases compared to neurosurgery. Notably, over half of the infected patients had received prophylactic antibiotics within 30 minutes before incision.

Conclusion:

SSIs remain a substantial postoperative complication, particularly in diabetic and laparotomy patients. Adherence to comprehensive infection control practices beyond antibiotic timing is crucial to minimize infection risk.

INTRODUCTION

Surgical site infections (SSIs) remain a major healthcare-associated complication globally and in India, leading to prolonged hospitalization, increased morbidity, and elevated healthcare costs.[1,2] Although SSI prevalence in Indian settings varies—from approximately 3% to over 12% in tertiary care centres—it often exceeds rates reported in high-income countries.[1,3] Among multiple factors associated with SSI risk, diabetes mellitus has consistently emerged as a key determinant, impairing wound healing and predisposing to infection in surgical patients.[1,4] Additionally, elective abdominal surgeries such as laparotomies carry higher SSI rates compared to more sterile procedures like neurosurgery, especially in low- and middle-income regions.[3,5] Timely administration of prophylactic antibiotics is recommended to reduce SSI, with most guidelines advocating dosing within 60 minutes prior to incision; however, large meta-analyses suggest that as long as antibiotics are given within 120 minutes, precise timing within that window may not significantly impact infection risk.[2] This study aims to determine the prevalence, demographic and procedural risk factors—including age, sex, diabetes status, procedure type, antibiotic timing, and surgical duration—for early SSIs following elective neurosurgery and elective laparotomy in a tertiary care hospital in central India.

MATERIAL AND METHODS

This prospective observational study was conducted over one year (post-approval Ref. EC/MGM/JULY-21/52) at Mahatma Gandhi Memorial Medical College and Maharaja Yeshwant Rao Hospital, Indore, under the Infection Control and Prevention Committee. Patients undergoing elective neurosurgical or laparotomy procedures were enrolled, excluding those who underwent day-care surgeries or were discharged within 72 hours. Each patient was assigned a unique identifier, and data on demographics, comorbidities, prior infections, and clinical records were collected and verified with surgical teams when needed.

Operative and postoperative parameters, including surgical duration, intraoperative complications, and wound status, were recorded. Wound evaluation was done at the first dressing change or on postoperative day three as per institutional protocol. SSIs were identified and classified according to CDC/NHSN surveillance criteria.

Details of antibiotic prophylaxis—timing, route, dosage, and modifications—were documented. In SSI cases, wound cultures and sensitivity testing were performed to identify causative organisms and resistance patterns.

Patients were followed until discharge, death, or leaving against medical advice (LAMA). The prevalence of SSIs was calculated using the formula:

Prevalence (%) = (Number of Infected Cases/Total Surgeries Performed) × 100.

OBSERVATION AND RESULTS

The overall SSI prevalence was 15.53%, with most cases occurring in the 21–60 year age group and predominantly among males [Figure 1]. Diabetes was the most common comorbidity, though many patients had no underlying illness [Figure 2]. SSI incidence was notably higher in laparotomy cases compared to neurosurgery [Figure 3], and over half of the infections occurred despite timely preoperative antibiotic administration, indicating that timing alone may not ensure prevention [Figure 4]. Longer operative durations were associated with a higher frequency of SSIs, particularly in neurosurgical procedures where the majority of infections occurred in surgeries lasting more than two hours [Figure 5].

Figure 1.

Age and Gender profile of SSI patients

Figure 2.

Co-morbidity profile of SSI patients

Figure 3.

Surgical profile of SSI patients

Figure 4.

Preoperative antibioticprophylaxisin SSI patients

Figure 5.

SSI distribution and duration on surgery

DISCUSSION

The observed SSI prevalence of 15.53% in this study exceeds the rates reported in recent Indian studies (5–8%)[6,7] and global estimates, which are generally below 10%,[8] indicating a heightened risk in specific surgical populations. SSIs were predominantly seen in patients aged 21–60 years, with a male preponderance, aligning with earlier findings that younger males are more susceptible to SSIs.[6,9] Diabetes mellitus emerged as the leading comorbidity, consistent with its well-established impact on delayed wound healing and immune compromise.[6,10]

Laparotomy was associated with significantly higher SSI rates compared to neurosurgery, echoing global and regional studies that identify abdominal surgeries as high-risk, especially in low- and middle-income settings.[6,11] This reinforces the need for heightened infection prevention strategies in abdominal procedures.

Interestingly, more than half of the SSIs occurred despite administration of prophylactic antibiotics within 30 minutes before incision. This is consistent with evidence suggesting that SSI rates do not significantly differ within the 30–60-minute window, as long as antibiotics are administered within the recommended 60-minute pre-incision period.[2,12] However, timing outside a broader 120-minute window, either too early or post-incision, is associated with higher infection risk.[2]

Overall, these results highlight the critical importance of focused SSI prevention strategies in high-risk groups, including diabetics, laparotomy patients, and those undergoing prolonged surgeries, through strict protocol adherence and operative efficiency.

CONCLUSION

Surgical site infections remain a significant concern, with a prevalence of 15.53% in elective neurosurgical and laparotomy cases in our tertiary care setting. Diabetes mellitus, prolonged surgical duration, and laparotomy procedures were major contributors to increased SSI risk. Strengthening infection control practices and ensuring strict adherence to perioperative antibiotic protocols are essential to reduce SSI incidences.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.