Work

Pandemic shadows in the operating room how COVID-19 altered the risk and timing of surgical site infections: a multivariable risk assessment and time-to-event analysis in a cohort of abdominal surgery patients

Year: 2025

Type: article

Abstract: BACKGROUND: Surgical site infections (SSIs) are among the most frequent and preventable complications following abdominal surgery, influenced by patient, procedural, and systemic factors. The coronavirus disease 2019 (COVID-19) pandemic introduced new perioperative protocols-including universal masking, visitor restrictions, enhanced personal protective equipment (PPE) use, and modified operating-room workflows-that may have altered infection dynamics. This retrospective cohort study, conducted in a large tertiary center in Saudi Arabia, examined whether these changes affected SSI risk and timing using survival analysis. OBJECTIVES: To determine SSI incidence, identify independent risk factors, and assess how the COVID-19 pandemic influenced infection onset and outcomes among patients undergoing abdominal surgery. METHODS: We reviewed 809 adult abdominal-surgery cases between January 2019 and December 2022. Data were extracted from the hospital's electronic health-record system by two independent reviewers using a standardized form under institutional approval (IRB No. E-22-6926). Data confidentiality was strictly maintained. SSIs were defined according to the U.S. Centers for Disease Control and Prevention (CDC) criteria. Multivariable logistic regression identified independent predictors, while Kaplan-Meier and Cox regression analyses evaluated infection-free survival and time-to-event outcomes. RESULTS: Of 809 patients, 47 (5.8%) developed SSIs, a rate consistent with international benchmarks. Independent predictors included diabetes mellitus (adjusted odds ratio [OR] 2.14; 95% CI 1.05-4.34), contaminated wounds (OR 3.67; 95% CI 1.58-8.54), and postoperative hyperglycemia ≥ 7 mmol/L (OR 2.95; 95% CI 1.32-6.57). During the pandemic, infections occurred later in the postoperative course, suggesting a delayed onset despite similar median times to infection. No multicollinearity was observed, and model diagnostics confirmed stability. CONCLUSION: SSIs remain a significant postoperative concern. Diabetes, wound contamination, and hyperglycemia were consistent predictors. Pandemic-related procedural adaptations may have delayed infection onset, underscoring the need for extended postoperative surveillance and context-specific infection-control strategies during public-health emergencies.

Source: BMC Infectious Diseases

DOI: 10.1186/s12879-025-12115-7