31.5.19 Determine the Frequency of Surgical Wound Infection in Patients Undergoing Elective and Emergency Abdominal Surgery

Original Article

 

Surgical Wound Infection in Elective and Emergency Surgery

Determine the Frequency of Surgical Wound Infection in Patients Undergoing Elective and Emergency Abdominal Surgery

Muhammad Kashif1, Jehangir Khan2, Ziaullah1 and Muhammad Bilal3

ABSTRACT

Objective: To examine the incidence of surgical wound infection in patients undergoing elective and emergency abdominal surgeries.

Study Design: Prospective/observational study

Place and Duration of Study: This study was conducted at the Department of Surgery, Bacha Khan Medical complex Swabi during from April 2019 to Dec 2019.

Materials and Methods: Three hundred and twenty patients of both genders were underwent abdominal surgeries. Patient’s ages were ranging from 5 to 65 years. Patients detailed demographics including age, sex, BMI, type of surgery, comorbidities were recorded after informed consent. Incidence of post-operative wound infection was examined and compare the findings between elective and emergency surgeries.

Results: One hundred and ninety (59.38%) were males while 130 (40.62%) were females. 64 (20%) patients were ages <20 years, 160 (50%) were ages 21 to 40 years, 70 (23.75%) were ages 41 to 60 years and 20 (6.25%) had ages above 60 years. 120 (37.5%) patients were underwent elective and 200 (62.5%) underwent emergency surgeries. Overall post-operative wound infection was found in 52 (16.25%) patients while 268 (83.75%) patients had no wound infection. In elective surgeries 8 (6.67%) patients developed wound infection while in emergency 44 (22%) developed wound infection, a significant difference was observed between elective and emergency abdominal surgeries with p-value 0.012.

Conclusion: The frequency of wound infection in our settings was high in patients received elective and emergency abdominal surgeries. Moreover, rate of surgical wound infection was high in emergency surgeries as compared to elective.

Key Words: Abdominal surgery, Elective, Emergency, Post-operative wound infection

Citation of article: Kashif M, Khan J, Ziaullah, Bilal M. Determine the Frequency of Surgical Wound Infection in Patients Undergoing Elective and Emergency Abdominal Surgery. Med Forum 2020;31(5):82-85.

 

 

INTRODUCTION

Postoperative wound infection, otherwise called surgical site infections (SSIs), confound the recuperation course of numerous patients. As characterized by the Centers for Disease Control and Prevention (CDC), these contaminations regularly happen inside 30 days of an activity at the site or part of the body where the medical procedure occurred, or inside a year if an embed is left set up and the disease is believed to be optional to medical procedure.1-3

 

 

1. Department of Surgery / Paediatric Surgery Unit2, Gajju Khan Medical College Swabi.

3. District Urologist, Bacha Khan Medical Complex Swabi.

 

 

Correspondence: Dr Muhammad Kashif, Assistant Professor of Surgery Gajju Khan Medical College Swabi.

Contact No: 0333 9416505

Email: marooshlab197@ gmail.com

 

 

Received:    January, 2020

Accepted:    February, 2020

Printed:        May, 2020

 

 

Bacterial colonization on the patient's skin and nutritious and genital tract are the chief contributing sources that lead to SSIs.4 The living being regularly disconnected is Staphylococcus aureus.5 Exogenous sources, for example, penetrates in clean method and working room gear may contribute, but significantly less often than endogenous greenery. Microscopic organisms inside the tissue or organ space frustrate the postoperative mending forms, and can prompt anastomotic releases, wound dehiscence, and shallow incisional contaminations.6

The paces of SSI are a lot higher with stomach medical procedure than with different sorts of medical procedure, with a few planned examinations showing a frequency of 15%–25% relying upon the degree of tainting.7,8 Careful site disease is preventable and is related with high dismalness and mortality. Notwithstanding the overwhelming effect on the patient's course of treatment, it is related with delayed length of medical clinic remain and greater expenses.9

Different hazard factors for SSI have been recognized after some time and would all be able to be accumulated inside at least one of the three significant determinants of SSI: bacterial components, nearby twisted variables, and patient elements. Bacterial variables remember harmfulness and bacterial burden for the careful site. Length of preoperative remains, remote site contamination at the hour of medical procedure, and term of the methodology have likewise been related with an expanded bacterial burden and SSI rate.10 Nearby twisted components are identified with the intrusiveness of an activity and to explicit specialist's practices and careful strategy. Great careful strategy while overseeing tissues (neighborhood twisted) in the most fitting way and utilizing stitches, channels, and outside bodies just with sufficient sign is the most ideal approach to keep away from SSIs.11 The present study was conducted aimed to examine the incidence of wound infection in patients undergoing elective and emergency abdominal surgeries.

MATERIALS AND METHODS

This prospective/observational study was conducted at Department of Surgery Bacha Khan Medical complex Swabi from 1st April 2019 to 31st Dec 2019. A total 320 patients of both genders undergoing elective and emergency abdominal surgeries such as appendectomy, hernia repair, pancreatitis, laparotomy, colon injuries, cholecystectomy and urethroplasty were included in this study. Patient’s ages were ranging from 5 to 65 years. Patient’s detailed demographics including age, sex, BMI, type of surgery (elective and emergency),
co-morbidities such as diabetes mellitus, anemia, hypertension, and smoking were recorded after informed consent. Patients with gynecological disorders, surgeries other than abdominal, patients with liver cancer and those with no consent were excluded. All the patients were received elective or emergency surgery whether it was laparoscopic or open procedure. Post-operative wound infection was examined at post-operative 1 week and at 1 month. Types of wound infection such as superficial and deep surgical site infection were examined. Compare the findings between elective and emergency surgeries. Data was analyzed by SPSS 24. Chi-square test was applied to compare the frequency of wound infection between elective and emergency surgeries. P-value <0.05 was taken as statistically significant.

RESULTS

There were 190 (59.38%) were males while 130 (40.62%) were females. 64 (20%) patients were ages <20 years, 160 (50%) were ages 21 to 40 years, 70 (23.75%) were ages 41 to 60 years and 20 (6.25%) had ages above 60 years. 120 (37.5%) patients were underwent elective and 200 (62.5%) underwent emergency surgeries. Mean BMI of all the patients was 26.25±4.32 kg/m2. The most common co-morbidity was anemia found in 76 (23.75%) patients followed by diabetes in 60 (18.75%) patients, hypertension in 52 (16.25%) patients and smoking found in 48 (15%) patients respectively (Table 1). Overall post-operative wound infection was found in 52 (16.25%) patients in which 36 (11.25%) developed superficial while 16 (5%) developed deep surgical site infection while 268 (83.75%) patients had no wound infection (Fig. 1). According to the comparison of postoperative wound infection between elective and emergency surgeries we found that in elective surgeries 8 (6.67%) patients developed wound infection while in emergency 44 (22%) developed wound infection, a significant difference was observed between elective and emergency abdominal surgeries with p-value 0.012 (Table 2).

Table No.1: Demographics of all the patients

Variables

No.

%

Gender

Male

190

59.38

Female

130

40.62

Age (Years)

<20

64

20.0

21 to 40

160

50.0

41 to 60

76

23.75

Above 60

20

6.25

Surgery type

Elective

120

37.50

Emergency

200

62.50

Co-morbidities

Anemia

76

23.75

Diabetes

60

18.75

Hypertension

52

16.25

Smoking

48

15.0

BMI (kg/m2)

26.25±4.32

Table No.2: Comparison of wound infection between elective and emergency abdominal surgeries

Post-operative wound infection

Elective

Emergency

P-value

Yes

4 (6.67%)

22 (22%)

0.012

No

56(93.33%)

78 (78%)

Figure No.. 1: Incidence of post-operative wound infection among all the patients

DISCUSSION

Abdominal surgeries such as appendectomy, gastrointestinal, exploration laparotomy, pancreatitis, and cholecystectomy were the most common surgeries performing in any surgical settings. Post-operative wound infection is the most frequency post-operative complication in abdominal surgeries and it can lead to increase hospital stay, cost and impacted worsened in patients.12,13 In surgical settings elective and emergency surgeries are performing. Patients with critical condition may receive emergency and patients with non-critical condition first received medical treatment than take these patients towards surgical intervention. We performed this study to examine the frequency of post-operative wound infection in patients undergoing elective and emergency abdominal surgeries. In this study total 320 patients received elective or emergency abdominal surgeries during the study period. Male patients were high in numbers 59.38% as compared to female 40.62%. Majority of patients (70%) were ages less than 40 years. These results showed similarity to many of previous studies in which males were predominant as compared to females and accounted 55% to 65% and the average age of patients whom were received abdominal surgeries was 26 years.14,15

In present study we found that 120 (37.5%) patients were underwent elective and 200 (62.5%) underwent emergency surgeries. Mean BMI of all the patients was 26.25±4.32 kg/m2. The most common co-morbidity was anemia found in 76 (23.75%) patients followed by diabetes in 60 (18.75%) patients, hypertension in 52 (16.25%) patients and smoking found in 48 (15%) patients respectively. A study conducted by Alkaaki et al16 reported that 76.3% patients were underwent elective surgery while 23.7% were underwent emergency surgery and among all the patients diabetes mellitus was the most common co-morbidity reported in 20.8% patients followed by smoking.

We found that the overall incidence of post-operative wound infection reported in 52 (16.25%) patients in which 36 (11.25%) developed superficial while 16 (5%) developed deep surgical site infection while 268 (83.75%) patients had no wound infection.  A study conducted by Prashant et al17 demonstrated that the overall incidence of wound infection was 24% and among elective surgery it was 4% and in emergency surgery in was 44%. Another study conducted by Kumar et al18 regarding incidence of wound infection in elective and emergency abdominal surgeries and they reported that surgical site infection was observed in 12.5%. Among the 3 types, superficial incision SSI was most prevalent followed by deep incisional SSI and finally by organ/space SSI. Some other previous studies showed similarity to over study findings regarding wound infection in which wound infection reported 15% to 40% patients and superficial infection was the most common surgical site infection.19,20

In present study according to the comparison of postoperative wound infection between elective and emergency surgeries we found that in elective surgeries 8 (6.67%) patients developed wound infection while in emergency 44 (22%) developed wound infection, a significant difference was observed between elective and emergency abdominal surgeries with p-value 0.012. These results were similar to the study by Kumar et al18 in which patients with emergency surgery had high rate of wound infection as compared o elective surgery. A study by Tan et al21 reported dissimilarity in which elective surgery reported a higher rate of SSIs, 19.40%, as compared with 15.47% in emergency surgery. Nagur et al22 reported that the incidence of wound infection was high in patients underwent emergency surgery as compared to the elective surgery.

CONCLUSION

The frequency of wound infection in our settings was high in patients received elective and emergency abdominal surgeries. Moreover, rate of surgical wound infection was high in emergency surgeries as compared to elective. Superficial surgical site infection was most common among all the patients.

Author’s Contribution:

Concept & Design of Study:

Muhammad Kashif

Drafting:

Jehangir Khan

Data Analysis:

Ziaullah, Muhammad Bilal

Revisiting Critically:

Muhammad Kashif, Jehangir Khan

Final Approval of version:

Muhammad Kashif

Conflict of Interest: The study has no conflict of interest to declare by any author.

REFERENCES

1.      Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13(10):606–8.

2.      Barie PS, Wilson SE. Impact of evolving epidemiology on treatments for complicated skin and skin structure infections: the surgical perspective. J Am Coll Surg 2015;220(1):105–6.

3.      Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309–32.

4.      Altemeier WA, Culbertson WR, Hummel RP. Surgical considerations of endogenous infections – sources, types, and methods of control. Surg Clin North Am 1968;48(1):227–40.

5.      Cheadle WG. Risk factors for surgical site infection. Surg Infect (Larchmt. 2006;7 Suppl 1:S7–11.

6.      Anderson DJ. Surgical site infections. Infect Dis Clin North Am 2011; 25(1):135–53.

7.      Azoury S, Farrow N, Hu Q, et al. Postoperative abdominal wound infection — epidemiology, risk factors, identification, and management. Chron Wound Care Manage Res 2015;2:137–48.

8.      Mawalla B, Mshana SE, Chalya PL, et al. Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania. BMC Surg 2011;11:21.

9.      Allegranzi B, Nejad SB, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377:228–41.

10.  Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91(Suppl 3B):152S-7S.

11.  Daly JM, Weintraub FN, Shou J, Rosato EF, Lucia M. Enteral nutrition during multimodality therapy in upper gastrointestinal cancer patients. Ann Surg 1995;221:327-38.

12.  Natalie L, Semchyshyn N. Dermatological surgical complications. (Online) updated May 29, 2009 Available at: http://www.emedicine.com/derm/ topic829.htm 2.

13.  Jawaid M, Masood Z, Iqbal SA. Post-operative complications in a general surgical ward of a teaching hospital. Pak J Med Sci 2006;22:171-5

14.  Dhaigude BD, Shree S, Shah P, Francis M, Patel K, Metta V. Post-operative wound complications following emergency and elective abdominal surgeries. Int Surg J 2018;5:232-7.

15.  Jagadamba Sharan, Rohit Tiwary, Md Arshad Raza, CGS Chauhan. Surgical site infections in elective abdominal surgery and their prevention in a tertiary care centre of Rohilkhand region. Int J Contemp Med Surg Radiol 2018;3(2):B151-5.

16.  Alkaaki A, Al-Radi OO, Khoja A, et al. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg 2019; 62(2):1117.

17.  Prashant S, Sunil V, Tanmay A. Study of surgical site infection in emergency and elective laparotomies. J App Med Sci 2017; 5(11F):
4750-56.

18.  Kumar A, Rai A. Prevalence of surgical site infection in general surgery in a tertiary care centre in India: Int Surg J 2017;4(9):3101-6.

19.  Kamath N, Swaminathan R, Sonawane J, Bharos N. Bacteriological profile of surgical site infections in a tertiary care center in Navi Mumbai. Proceedings of the 16th Maharashtra chapter conference of IAMM 2010;11:24-6.

20.  Ahmad F, Yar A, Rehman SA, Anjum Z, Ahmad A. Frequency of surgical site infections in clean and clean contaminated surgeries in Bahawal Victoria Hospital, Bahawalpur: Pak J Surg 2018; 34(4): 273-8.

21.  Tan LT, Shiang F, Wong J, Azmah Tuan Mat TN, Gandhi A. A prospective study of surgical site infection in elective and emergency general surgery in a tertiary Public Hospital in Malaysia - a preliminary report. Madridge J Surg 2019; 2(1): 52-8.

22.  Janugade HB, Nagur BK, Sajjan KR, Biradar SB, Savsaviya JK, Reddy M. Abdominal Surgical Site Infection Occurrence and Risk Factors in Krishna Institute of Medical Science, Karad. Int J Sci Stud 2016;3(11):53-6.