Infections after abdominal surgery

Objectives: To determine surgical site infection (SSI) rates, after abdominal Surgery and To determine risk factors associated with surgical site infections. Settings: AL-Jumhoori Teaching Hospital, Department of surgery, Mosul Medical City, Mosul, Iraq. Starting from October 2007-October 2008. Patients and methods: A prospective cohort study included 78 patients with surgical site infection after elective and emergency abdominal surgery. The dependent factors was abdominal surgical site infection, defined as redness, swelling, pain, warmth, pus discharge, during the 30 days after operation. The independent variables were age, sex, body mass index ,time, type of surgical operation, duration of hospital stay and risk factors promoting SSI. All four wound categories: clean, clean-contaminated, contaminated and dirty wounds were included. Surgical site infections are divided into superficial incisional, deep incisional and organ space SSI. Results: 485 patients Operated on for elective and emergency abdominal surgery, 78 (16%) developed SSIs, included 46 female (59%) and 32 male (14%). The peak age incidence was above sixty years (20%).SSI was associated with obesity. Superficial incisional infections founded in 45 (58%) , 21 (27%) for deep incisional and 12 (15%) was organ space SSI.SSIs incidence in complicated appendicitis (20.5%), penetrated injuries (15.38%), non-complicated appendicitis (10.259%), perforated duodenal ulcer (10.25%) and mesenteric ischemia (7.69%) .SSIs founded in (23%) elective operations, emergency atraumatic operations in (57%), penetrating operations (15%) and blunt trauma operations in (5%). Incidence of SSls was (5%) in clean wounds, (12%) in clean- contaminated,(28%) in contaminated and (46%) in dirty wounds. Staphylococcus aureus was predominantly (80%) isolated from clean wounds, while polymicrobial flora in contaminated and dirty wounds. Important risk factors associated with SSI were systemic shock (30%), prolonged operation (22%), anemia (19.7%), associated chronic diseases (14%). The mean hospital stay for patients with SSI was 11 days. Conclusions: SSls are frequent in elderly, obesity, emergency operations and dirty wounds. Shock, prolonged operation, anemia, chronic diseases are important risk factors Mean hospital stay was doubled and cost was elevated with postoperative infection.