Comparison of Surgical Site Infections in Emergency Laparotomy and Elective Laparotomy

Abstract

Objective: This study aimed to find out the frequency, microbiological profile, pattern and predictors of wound site infections comparing emergency and elective midline laparotomy.
Study Design: Prospective comparative observational study.
Place and Duration of Study: was conducted in Department of General Surgery Hayatabad Medical Complex, Peshawar from 1 February 2024 to 30 September 2025.
Materials and Methods: The complete data was collected on a standardized proforma. Patients were operated and post-operative data was collected during follow-up for one months.
Results: Among 328 patients, 200 (60.9%) underwent emergency and 128 (39.1%) elective laparotomies. Baseline demographics, ASA class, and comorbidities were comparable between groups. Emergency surgeries had longer operative duration (p < 0.001), higher peritoneal contamination (63% vs. 3.1%) (p < 0.001), more contaminated/dirty wounds (p < 0.001), and greater ICU admission (37.5% vs. 17.1%) (p < 0.001). Surgical site infection (SSI) was significantly higher after emergency surgery (17.0% vs. 7.8%), with more superficial and
deeper or organ-space infections (p < 0.001). Emergency cases also showed higher rates of reoperation, readmission, 30-day mortality (5.5%), and longer hospital stay (8.7 ± 4.7 vs. 6.9 ± 1.9 days).
Conclusion: Surgical site infections were frequently higher in emergency laparotomy than in elective laparotomy, driven by contamination, wound class, and operative complexity. Several risk factors in emergency signify risk of SSI, like contamination, prolonged operative duration and intra-abdominal sepsis.