Surgical site infections after abdominal surgeries: a prospective multicentre study in 53 Nigerian hospitals

Introduction: Surgical site infection (SSI) remains a significant challenge in surgical care, particularly in low- and middle-income countries like Nigeria. Limited access to reliable, up-to-date data has hindered efforts to reduce this burden. This study provides a snapshot audit of SSI incidence and influencing factors in Nigeria, the largest country in sub-Saharan Africa. Methods: We conducted a multicentre prospective cohort study using a collaborative network of surgeons across 53 hospitals in Nigeria between June and August 2024, enrolling 2466 patients undergoing abdominal operations with incisions of at least 5 cm in adults or 3 cm in children. Caesarean sections were excluded. SSI was defined based on Centres for Disease Control and Prevention criteria and monitored at discharge and on postoperative day 30. Predefined risk factors assessed included patient characteristics, surgical factors and perioperative practices. Associations were examined using a multilevel logistic regression model with hospital as a random intercept to account for clustering. Results: Of the 2466 recruited patients, 2240 were included in the final analysis. Over half (56.4%) underwent emergency surgery. Open procedures were performed in 98.3% (2202) of cases, with general anaesthesia administered to 77.8% (1741) of patients. The WHO Surgical Safety Checklist was used in 69.9% (1564) of cases. Overall, 26.4% (591) of patients developed SSI within 30 days postsurgery. Predictors of SSI include preoperative haematocrit (packed cell volume), smoking status, HIV status and emergency surgery. In a multivariable analysis, American Society of Anaesthesiologists (ASA) grades 3–5: OR 1.91 (1.48 to 2.45, p<0.001), contaminated/dirty contamination: OR 5.48 (3.33 to 9.01, p<0.001) and open midline approach: OR 1.41 (1.06 to 1.88, p=0.020) were significantly associated with higher odds of SSI. Conclusion: Abdominal surgeries in Nigeria are associated with a high SSI rate, which contributes to adverse postoperative outcomes in patients. Identifying modifiable risk factors could help inform national policies aimed at SSI prevention.