Risk Factors for SSI and Wound Dehiscence in Pediatrics Surgical Patients in Tikur Anbessa Hospital, Ethiopia

Author(s):
Abay Gosaye; Fisseha Temesgen ; Nichole Starr; Tihitina Negussie

Background:

Surgical site infection (SSI) and wound dehiscence are two early complications of laparotomy, representing a source of significant morbidity and mortality. This study was conducted to determine the prevalence and risk factors of SSI and wound dehiscence in pediatric surgical patients at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia

Hypothesis:

We hyphothesized risk factors for SSI and wound dehiscence would be similar to pediatrics surgical patients in other low resource settings.

Methods:

We performed a prospective observational study of all pediatric surgical patients at TASH from December 1, 2015 to May 31, 2016.  Patient data collected included demographics, operative indication, nutritional status, prophylactic antibiotics administration, and duration of operation. Primary outcome was SSI while secondary outcomes were duration of hospital stay and other postoperative complications, including mortality. Data analysis was performed using SPSS Version 23. Chi-square and Fisher’s exact tests were used to report outcomes stratified by patient characteristics. Multivariable logistic regression was used to identify patient variables associated with SSI, wound dehiscence and other outcomes.

Results:

A total of 114 patients were included in the study; 67.5% were male and 32.5% were female; with a male to female ratio of 2:1. Patient age ranged from 1 day to 12 years with median age of 35.6 months. Neonate (<1 month) accounted for 11.4% while infant (1-12 months), under five (1-5 years) and older than five (>5 years) accounted for 26.3%, 25.4% and 36.8% respectively. Overall incidence of SSI was 21.1%. 8% percent of the patients developed wound dehiscence while 2.6% had eviceration of abdominal contents. The overall mortality rate was 2.6%. Multivariate analysis showed that timing of prophylactic antibiotics administration (OR adjusted= 13.05, (p=0.006)), duration of the procedure (OR adjusted= 8.62, (p=0.012)) and wound class (OR adjusted= 16.63, (p=0.034)) were found to be independent risk factors for SSI but not for wound dehiscence. Presence of SSI was an independent predictor of prolonged hospital stay greater than one week (OR adjusted=4.7, p=.003,). Age (p= .004) and malnutrition (p<.001) were significantly associated with wound dehiscence. SSI was also found to be an independent predictor of wound dehiscence (OR adjusted=33. 96, p=.003).

Conclusions:

The incidence of SSI and wound dehiscence is high in this setting. Wound contamination, antibiotics administration greater than one hour before surgery and prolonged duration of the procedure greater than two hours are independent predictors for development of SSI.