Incidence and outcomes of surgical site infection following emergency laparotomy during the COVID-19 pandemic in a low resource setting: A retrospective cohort

Abstract

Introduction Surgical site infection (SSI) is the commonest form of hospital acquired infection in sub-Saharan Africa, associated with increased morbidity and mortality. This study was aimed at determining the incidence and outcomes of surgical site infection following emergency laparotomy during the COVID -19 pandemic in a low resource setting. Methods This was a retrospective single Centre cohort of patients that had emergency laparotomy between July 2021–June 2022 (COVID period) and July 2018–June 2019 (pre-COVID period). Analysis was done using SPSS version 22 in which SSI rates were compared between the two periods using the chi squared test. Mortality, re-operation rates and length of hospital stay were also compared. Results Of the 453 patient files included in analysis, 244 (53.9%) were for the COVID period, while 209 (46.1%) were for the pre COVID period. The incidence of SSI was insignificantly higher in the COVID period (17.6% versus 16.7%; P = 0.901). Mortality was also insignificantly higher in the SSI group (3.8% versus 3.5%; P = 0.745). Presence of surgical site infection increased the risk for re-operation (P < 0.001) and prolonged hospital stay (P < 0.001). Conclusion Since the incidence and outcomes of surgical site infection appear not to have changed following the pandemic, the same measures that were previously used to prevent SSI could still be effective even during the pandemic if followed appropriately and combined with the COVID specific peri-operative care recommendations. High lights

Cohort study to characterise surgical site infections after open surgery in the UK’s National Health Service

“…A recent publication reported a similar observation among those who underwent emergency abdominal surgery in Uganda. 37 The evidence for the effect of the COVID-19 pandemic in the elective setting points towards a reduction in SSI incidence (possibly as a result of increased use of personal protective equipment, etc). 38 39 …”

Cambio rutinario de instrumental y guantes quirúrgicos en cirugía abdominal: ¿cuál es el impacto sobre el riesgo de infección?

“…(25) Se sugiere que, principalmente en estos casos, sobre todo cuando el paciente presenta antecedentes de diabetes mellitus, inmunosupresión o alcoholismo, se use el equipo de protección personal completo por parte del equipo quirúrgico. (25)(26)(27) El estudio TRISTAN, que evaluó sí el uso de sutura recubierta con triclosán (5-cloro-2-(2,4-diclorofenoxi)fenol) tenía el potencial de disminuir la incidencia de ISO en cirugía abdominal, demostró que, luego de meta-analizar ocho ensayos controlados aleatorizados, evidentemente el uso de sutura recubierta por triclosán para cierra de fascia fue superior comparada a no usarla (OR 0,67; IC 95%: 0,46 -0,98), en la reducción de la ISO. (28) Sin embargo, tal y como se discutía previamente, considerando las variables que pueden influir en este desenlace, estos resultados no se pueden extrapolar tan fácilmente.…”