Abstract
Objective: This study aimed to evaluate associations of intra-operative risk factors and the WHO Surgical Safety Checklist with the incidence of surgical site infections (SSIs) following abdominal surgery up to 30 days post-surgery.
Background: SSIs pose a significant challenge in healthcare, particularly after major abdominal surgery. Implementing the Surgical Safety Checklist is considered a strategy to mitigate the risk of SSIs. Evidence on intra-operative risk factors contributing to post-discharge SSIs, especially in abdominal surgery patients, is limited.
Method: A retrospective observational, cohort study was conducted over 5 years at a Norwegian university hospital, and included adult patients undergoing colon resection, cholecystectomy, and caesarean sections. Standardised anaesthetic techniques were applied, and core body temperatures were routinely recorded at the start and end of surgery. Data were collected from an administrative operation planning system and SSIs register. SSIs were monitored according to the Norwegian national surveillance system on Surgical Site Infections (NOIS) and The Healthcare-Associated Infections Surveillance Network (HAI-Net), with additional patient and physician-reported data on wound infections. The probability of SSIs was analysed using multiple logistic regression.
Results: A total of 11.2% (463/4142) of patients developed SSIs, of which 4.6% (189/4142) developed SSIs after discharge from hospital. Age, gender, forced air warming blankets, fluid warmer, volume of intravenous fluids, and the Surgical Safety Checklist use were not associated with the total number of SSIs. Perioperative temperature, duration of surgery, open surgical access, type of surgery, regional anaesthesia, and higher comorbidity were observed as risk factors. A significant association was found between omitting use of the WHO SSC Time-Out component and post-discharge SSIs, with a fully adjusted odds ratio of 1.95. The incidence of SSIs after discharge was also associated with factors such as perioperative temperature.
Conclusion: The WHO SSC may predominantly impact the incidence of SSIs after discharge. Moreover, intra-operative work processes such as shorter duration of surgery and maintaining perioperative normothermia may protect against SSIs.
Clinical Trial Identifier:NCT03112317