PREVALENCE AND RISK FACTORS OF SURGICAL SITE INFECTION IN A MILITARY GENERAL SURGERY

WARD: AN OBSERVATIONAL STUDY

Kathrine Marie B Montejo, MD; Ma Cielo G Ampuan, MD
AFP Health Service Command- Victoriano Luna Medical Center

ABSTRACT RESULTS AND DISCUSSION

Surgical Site Infection (SSI) remains to be a common and CLINICAL CHARACTERISTICS OF MILITARY VS NON- MILITARY PATIENTS Characteristics of Military group
morbid complication in surgery. While common, there Prevalence of Surgical Site Age
remains a problem in its accurate documentation, Infection - Military mean age 36.1 (20-62 years old) is narrower than non- military patients (44.2, 0.01-
especially more so in the military hospital setting. Total: 3.26 88 years old) owing to age requirement for military service
Recognizing risk factors of surgical site infection in military Military group alone: 4.8 Sex
patients is imperative, as they are not only responsible for Non- military group alone: 1.85 - More females compared to males in the non- military group (193 vs 132) as compared to
their own well being, but of their families and country as military group (29 vs 260) as females are underrepresented in the service (Balibay, 2018)
well. The prevalence of SSI in military patients was 4.8, with Wound category
identified risk factors of Dirty wound, Emergency 614 patients - Military group had more contaminated wounds as compared to non- military group (9.1%
procedure, Exposure to Radiation and Steroid use, and Military 47% vs 1.6%).
Peripheral Vascular Disease. This study serves as a basis in Non- military 52.9% - Include anal cases (10%) such as hemorrhoidectomy and trauma cases (2.7%) probably
the institution for future surveillance of surgical site related to the nature of work which includes strenuous activities and violent encounters
infection, as well as basis for recommendations of
perioperative institutional guidelines.

RISK FACTORS OF SSI IN MILITARY VS NON- MILITARY PATIENTS

INTRODUCTION VARIABLES NON- MILITARY PATIENTS MILITARY PATIENTS IDENTIFIED RISK FACTORS IN MILITARY PATIENTS
RR (95% CI) p- value RR (95% CI) p- value
There is minimal documentation of surgical site infection in GENDER Male 1.46 (0.29-7.13) 0.638 3.33 (0.20- 54.47) 0.398
the tertiary military institution. This study aims to identify Female 0.68 (0.14-3.33) 0.638 0.30 (0.01-4.90) 0.398
AGE > 54 years old 0.69 (0.12- 3.73) 0.424 1.31 (0.18- 9.41) 0.786 Dirty wound (RR: 6.22)
the different factors of surgical site infection in military and < 54 years old 1.43 (0.26- 7.74) 0.424 0.76 (0.10- 5.46) 0.786 - these patients had gross contamination upon opening, specifically 6/14 had ruptured
non- military patients at the general surgical ward of a WOUND Clean 0.23 (0.01- 4.16) 0.325 0.25 (0.03- 1.91) 0.183 appendicitis with abscess formation, while 1/14 had perforated viscus with abscess
tertiary military hospital. CLASSIFICATION Clean Contaminated 3.33 (0.39- 28.20) 0.269 0.97 (0.34- 2.72) 0.954
formation
Contaminated 2.20 (0.13- 36.81) 0.580 0.14 (0.00- 2.33) 0.171
Dirty 1.38 (0.16- 11.56) 0.763 6.22 (2.30- 16.80) 0.0003

METHODOLOGY TYPE OF SURGERY Emergency

Elective
8.54 (1.00-72.25)
0.11 (0.01-0.99)
0.049
0.049
5.61 (1.81- 17.43)
0.17 (0.05- 0.55)
0.002
0.002
Emergency surgery (RR: 5.6)
- Conditions such as malnutrition, uncontrolled diabetes, and active smoking status are not
GENERAL ANESTHESIA Yes 8.19 (0.50-156.87) 0.134 0.64 (0.20- 1.99) 0.443
Retrospective cohort study utilizing review of records No 0.11 (0.005-1.97) 0.134 1.55 (0.50- 4.85) 0.443 optimized in emergency procedures
Included: Patients who underwent elective and emergency, RADIOTHERAPY USE Yes 25.07 (3.06-205.31) 0.002 10.00 (1.32- 75.62) 0.025
major and medium cases in VLMC from January – December No 0.03 (0.004-0.32) 0.002 0.10 (0.01- 0.75) 0.025 Radiation (RR: 10) and Steroids (RR: 10) suppress the immune system, making patients prone
STEROID USE Yes 25.07 (3.06-205.31) 0.002 10.00 (1.32- 75.62) 0.025
2018 regardless of age, sex, and co- morbidities. No 0.03 (0.004-0.32) 0.002 0.10 (0.01- 0.75) 0.025
to hospital acquired infections.
Excluded: Patients who underwent minor procedures in the PERIPHERAL VASCULAR Yes 25.07 (3.06-205.31) 0.002 10.00 (1.32- 75.62) 0.025
ER, OPD and at the ward DISEASE No 0.03 (0.004-0.32) 0.002 0.10 (0.01- 0.75) 0.025 Peripheral Vascular Disease (RR: 10) compromise the perfusion of oxygen and other nutrients
OR ROOM Dirty 2.01 (0.12-33.81) 0.625 0.96 (0.06- 15.12) 0.982
Risk ratio was calculated using MedCalc Software. necessary for wound healing.
Sterile 0.49 (0.02-8.29) 0.625 1.03 (0.66- 16.10) 0.982

CONCLUSION
• The prevalence rate is comparably lower as compared to studies in other low to mid- income countries but higher compared to high income countries
• Identified risk factors were dirty classification of wound, emergency surgery, exposure to radiation and steroid use, and peripheral vascular disease
• Other risk factors were not considered statistically significant, probably due to sample size
• This study can serve as basis for other observational studies and surveillance studies, and can be used as evidence for recommendations for institutional perioperative protocols