Surgical Site Infections After Laparotomy in a Tertiary Referral Hospital in Kenya: Incidence and Risk Factors

Globally, surgical site infection (SSI) remains a major nosocomial infection, contributing significantly to morbidity and mortality. Laparotomies are known to have higher reported rates of SSI compared to other types of surgery. SSI rates are generally higher in Low- and Middle-Income Countries (LMIC) than in High Income Countries (HIC) for similar surgical procedures, though specific rates in LMICs are often unknown. Identifying population-specific risk factors is critical for implementing effective SSI surveillance programs aimed at reducing the infection burden.

Data was collected retrospectively from 393 general surgery patients who underwent surgery between January 2022 and December 2023. The study included all patients aged 14 years and above who had an exploratory laparotomy performed by the general surgery team. Bivariate analysis was performed to establish associations between variables and SSI occurrence, followed by a stepwise multivariable logistic regression. SSI was defined as per the World Health Organization (WHO) and Center for Disease Control (CDC) criteria.

The overall complication rate among the 393 patients was 26.7%. The study identified 55 cases of SSI, yielding an overall SSI rate of 14.1%. 40.4% of SSI cases were classified as superficial, 32.7% as organ space, and 25% as deep. Wound culture was only performed in 24 patients, with Escherichia coli being the most common organism found. Multivariable logistic regression identified three independent predictors of increased SSI risk: Operative Time: Each additional hour of operative time was associated with a 68% increase in the odds of SSI (aOR = 1.68, 95% CI 1.149-2.455, p = 0.007). Sex: Female patients had 2.6 times higher odds of developing SSI compared to male patients (aOR = 2.599, 95% CI 1.251-5.399, p = 0.01). Wound Class: Dirty wounds were associated with 2.34 times higher odds of infection compared to clean wounds (aOR = 2.343, 95% CI 1.123-4.886, p = 0.023).

The SSI rate of 14.1% at MTRH highlights the considerable burden of infection following laparotomies in this setting. Operative duration, patient sex, and wound contamination level are critical, modifiable and unmodifiable, independent risk factors that should be targeted for surveillance and preventative programs in western Kenya.