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.

backgroundSurgical 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.

objectivesTo determine SSI incidence, identify independent risk factors, and assess how the COVID-19 pandemic influenced infection onset and outcomes among patients undergoing abdominal surgery.

methodsWe 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.

resultsOf 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.

conclusionSSIs 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.