Postoperative wound infection after elective abdominal gynecological procedures:  Incidence, risk factors, and treatment outcomes

Sehrish Razzaq; Nadia  Zahid; Gulfreen Waheed; Robina Kauser

doi:10.53685/jshmdc.v7i1.451

Authors

Sehrish Razzaq Avicenna medical college, Lahore
Nadia Zahid Avicenna Medical College, Lahore, Pakistan
Gulfreen Waheed Avicenna Medical College, Lahore, Pakistan
Robina Kauser Avicenna Medical College, Lahore, Pakistan

DOI:

https://doi.org/10.53685/jshmdc.v7i1.451

Keywords:

Wound infection,, Gynecological surgery, Antibiotic prophylaxis, Risk factors, Postoperative care

Abstract

Background: Postoperative wound infections are a significant complication of elective abdominal gynecological surgery, contributing to prolonged hospital stay, increased costs, and additional interventions.

Objectives: To determine the incidence of postoperative wound infections, identify associated risk factors, and evaluate treatment outcomes among women undergoing elective abdominal gynecological procedures.

Methods: This prospective observational study was conducted at Avicenna Medical College Hospital in Lahore from April to November 2025. Of 138 consecutively enrolled women, 23 were lost to follow-up, leaving 115 for final analysis. Risk factors were recorded, and all patients were followed for 30 days. Fisher's exact test and relative risk (RR) with 95% confidence intervals (CI) were calculated for statistical analysis.

Results: Cumulative incidence of postoperative wound infection was 12.17% (14/115), with 92.86% of cases detected after hospital discharge. Significant risk factors were duration of surgery >120 minutes (RR 4.26, p=0.013), intraoperative blood loss >500 ml (RR 4.05, p=0.018), and antibiotic administration <60 minutes before incision (RR 4.66, p=0.011). Antibiotic prophylaxis significantly reduced the risk of infection (RR 0.29, 95% CI 0.12–0.73, p=0.012). Elevated BMI, anemia, and diabetes showed increased risk but did not reach statistical significance. Infected patients had a longer hospital stay (4.4 days vs 2.0 days), corresponding to an excess of 2.4 days. Of 14 infected patients, 9 (64.3%) were managed conservatively, while 5 (35.7%) required surgical re-intervention. 50% required readmission for management.

Conclusion: Postoperative wound infection occurred in 12% of women, with 92.86% detected after discharge. Duration of surgery, blood loss, and delayed antibiotic administration were significant risk factors, whereas prophylaxis was protective. Most infections responded to conservative management, though 50% required readmission and 35.7% required re-intervention, underscoring the need for structured post-discharge surveillance.

References

Ekanem EE, Oniya O, Saleh H, Konje JC. Surgical site infection in obstetrics and gynaecology: prevention and management. Obstet Gynaecol. 2021;23(2):124–137.

Hou Y, Collinsworth A, Hasa F, Griffin L. Incidence and impact of surgical site infections on length of stay and cost of care for patients undergoing open procedures. Surg Open Sci. 2023;11:1–18.

Farooq M, Mahmood MA, Razzaq S, Batool M, Tahir TH, Hanif S. Effects of enhanced recovery after surgery protocol on outcome of surgical patients. Pak Armed Forces Med J. 2024; 74(4): 926–930.

Seidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: a review. JAMA. 2023;329(3):244–252.

Rezaei AR, Zienkiewicz D. Surgical site infections: a comprehensive review. J Trauma Inj. 2025; 38(2): 71.

Calegari IB, Peixoto CA, Furtado BEP, Raponi MBG, Felix MMS, Ferreira LA, et al. Post-discharge surveillance methods for infection of the surgical site: integrative review. Acta Paul Enferm. 2023;36:eAPE019631.

Taliento C, Scutiero G, Milano C, Grasso M, Nitti F, Brasile O, et al. Surgical site infections and sepsis in gynecological surgery. Int J Gynecol Obstet. 2026; 172(1): 92–103.

Malik SS, Malik TA, Siddiqui N, Khan AU, Ahmad K, Sultan F, et al. PakSurg 1: determining the epidemiology and risk factors of surgical site infections in Pakistan — a multicentre, prospective cohort study. BMJ Open. 2023;13(7):e070831.

Khan OH, Zakaria AD, Hashim MN, Khan AH, AlQarni A, AlGethamy M, et al. The burden of surgical site infection at Hospital Universiti Sains Malaysia and related postoperative outcomes: a prospective surveillance study. Antibiotics (Basel). 2023;12(2):208.

Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017; 224(1): 59–74.

Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013; 70(3): 195–283.

Petousis S, Angelou P, Almperis A, Laganà AS, Titilas G, Margioula-Siarkou C et al. Prophylactic antibiotics before gynecologic surgery: a comprehensive review of guidelines. Journal of Personalized Medicine. 2024; 14(3): 327.

Giouleka S, Tsakiridis I, Chalkia-Prapa EM, Katzi F, Liberis A, Michos G, et al. Antibiotic prophylaxis in obstetrics and gynecology: a comparative review of guidelines. Obstet Gynecol Surv. 2025; 80(3): 186–203.

Bardia A, Treggiari MM, Michel G, Dai F, Tickoo M, Wai M, et al. Adherence to guidelines for the administration of intraoperative antibiotics in a nationwide US sample. JAMA NetwOpen.2021;4(12):e2137296.

Rodríguez-Rodríguez N, Martínez-Jiménez I, García-Ojalvo A, Mendoza-Mari Y, Guillén-Nieto G, Armstrong DG, et al. Wound chronicity, impaired immunity, and infection in diabetic patients. MEDICC Rev. 2022; 24(1): 44–58.

Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, et al. Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2016; 37(1): 88–98.

Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Advances in wound care. 2015;4(9):560-82.

Gul N, Khan H, Asif M, Faiz U, Ullah H, Jabeen S. Comparison of surgical site infection in diabetic vs non-diabetic patients operated electively in surgical unit of MTI Lady Reading Hospital Peshawar. Biol Clin Sci Res J. 2025;6(1):18–21.

Arshad S, Rasul A, Batool A, Zukhruf Z, Asad MT. Diabetes and risk of surgical site infection: a narrative review. J Health Rehabil Res.2024;4(1):567–572.

Ghani MT, Rehman IU, Haider S, ur Rehman A, Zubair H. Microbiology and drug sensitivity of Surgical Site Infections in Pakistan: A Systematic Review. Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University. 2024; 20 (1) :3-7.