Surgical site infections following gastrointestinal surgery in Palestine: a multicentre,prospective cohort study

Background

Surgical site infection (SSI) is defined as operation-related infections that occur at or near surgical incisions within 30 days after surgery. SSI is the most common postoperative complication and leads to increased morbidity and mortality among surgical patients. In Palestine, prospective multicentre studies on the epidemiology of SSI are lacking. We aimed to describe SSI epidemiology following gastrointestinal surgery in Palestine.

Methods

We used data from an international study (GlobalSurg 2), which is a prospective, multicentre cohort study. The 11 participating hospitals (four in the Gaza Strip and seven in the West Bank) provided a 30-day follow-up for consecutive gastrointestinal surgical operations performed during a 2-week period between Jan 1 and July 31, 2016, with the follow-up for the last period ending on Aug 30, 2016. 30-day follow-up data collection included incidence of SSI or other hospital acquired infection, any unexpected re-intervention and 30-day mortality. The primary outcome was the occurrence of SSI within 30 days of surgery, and secondary outcomes were 30-day postoperative mortality rate and administration of perioperative antibiotics. We used RedCap for data management, and SPSS for data analysis. Ethics approval was obtained from the Palestinian Ministry of Health.

Findings

Data were included for 249 patients; 133 (53·4%) were male and the mean age was 29 years (SD 17). Of these individuals, 43 patients (17%) were current smokers, 13 (5%) had diabetes, and 197 (79%) were rated as healthy according to the American Society of Anaesthesiology classification. Of the operations, 142 (57%) were emergencies, 224 (90%) were clean-contaminated, 186 (75%) were open surgeries, and 144 (58%) involved appendectomy. Antibiotics were given preoperatively to 79 patients (32%) and at the point of incision to 128 (51%). In total, 24 patients (10%) developed SSI and 3 (1%) had an intra-abdominal or pelvic abscess. The average length of in-hospital postoperative stay was 3 days (SD 2·5). One patient (0·4%) died within 30 days of surgery (30-day mortality rate).

Interpretation

We observed a low rate of SSI (10%) and 30-day postoperative mortality rate (0·4%) compared with other low-income and middle-income countries (SSI rate of 23·2% to 14·0%, 30-day postoperative mortality rate of 4·8% to 1·6%, for low-income to middle-income countries, respectively). This may be attributable to the fact that most of our cases were healthy and had clean-contaminated wounds. The results should be interpreted cautiously because of limited sample size and event rates.

Funding

None.