One in every seven patients undergoing major abdominal surgery at a Kenyan referral hospital developed a surgical site infection, a new study has found, raising concern over the risks faced by patients who require urgent operations.
Researchers who studied 393 patients at the Moi Teaching and Referral Hospital (MTRH) found that 55 developed infections after surgery, giving an overall infection rate of 14.1 per cent.
The infections varied in severity. Some affected the surface of the surgical wound, while others were deeper and involved areas around the organs.
Although the study was carried out at MTRH, the researchers warned that the situation could be worse in lower-level health facilities.
Surgical site infections can force patients to remain in hospital longer and may require additional treatment. The study found that patients involved in the research stayed in hospital for an average of five days.
The Kenyan rate was also higher than the global figure reported by the World Health Organisation (WHO) for low- and middle-income countries.
In its 2018 Global Guidelines for the Prevention of Surgical Site Infection, WHO said: “In low- and middle-income countries, 11 per cent of patients who undergo surgery are infected in the process.”
The WHO document notes that surgical site infections affect millions of patients and also contribute to the spread of antibiotic resistance.
However, the researchers cautioned that the two figures should not be directly treated as a like-for-like comparison. The WHO estimate covers surgery across low- and middle-income countries, while the Kenyan study focused on one type of major abdominal operation at MTRH.
The researchers also said the 14.1 per cent rate could be lower than the actual number of infections because patients were only followed while they remained in hospital.
Those who developed infections after being discharged were therefore not captured in the study.
“The SSI (surgical site infection) rate of 14.1 per cent 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 programmes,” they said.
A large number of the patients underwent emergency operations, a factor the researchers linked to the high infection burden.
Of the 393 patients studied, 268, or 68.4 per cent, underwent emergency surgery. Only 89 patients, representing 22.7 per cent, had planned operations.
The risk was particularly high among patients who needed emergency surgery and arrived with wounds that were already badly contaminated or infected.
Among emergency operations, infections occurred in 5.7 per cent of patients with clean wounds. The rate rose to 8.8 per cent among those with clean-contaminated wounds.
It increased further to 13.6 per cent for contaminated wounds and reached 27.1 per cent among patients with dirty wounds.
This means more than one in four patients who underwent emergency surgery involving dirty wounds developed an infection.
The researchers said many of the patients referred to MTRH arrived with serious conditions, including perforated organs and infected tissue, placing them in higher-risk groups before surgery.
“The high percentage of emergent procedures (68.4 per cent) in this cohort likely contributes to this significant infection burden. A significant proportion of the participants presented as referrals with perforated viscera or infected tissue, classifying them into the higher-risk wound categories,” they said.
The findings also point to delays faced by some patients before reaching the operating room.
Among patients who required non-planned surgery, the middle waiting time from arrival at the emergency department to the operating room was 12 hours.
The researchers said the infection rate and the large number of emergency procedures highlight the need to pay close attention to patients undergoing abdominal surgery, particularly those arriving with contaminated wounds or serious conditions.
The study therefore points to both the condition of patients when they reach referral hospitals and the risks linked to emergency abdominal operations as key issues in preventing infections after surgery.