TY - JOUR
T1 - Epidemiology and risk factors of surgical site infections in elective surgeries in Pakistan (2022–2023)
T2 - a multicentre, prospective cohort study from PakSurg 1
AU - T.FirdousTabassumPakSurg Collaborative
AU - Waqar, Usama
AU - Ahmed, Shaheer
AU - Fatimi, Asad Saulat
AU - Ahmed, Warda
AU - Martins, Russell Seth
AU - Waheed, Haseeb
AU - Banani, Illiyun
AU - Ashfaq, Dahir
AU - Merchant, Asma Altaf
AU - Ukrani, Ronika Devi
AU - Abbas, Manzar
AU - Qadir, Muskan Abdul
AU - Tahir, Izza
AU - Khan, Daniyal Ali
AU - Rauf, Hareem
AU - Javaid, Mahnoor
AU - Raheel, Sarim
AU - Uzair, Muhammad
AU - Mahar, Muhammad Umar
AU - Virani, Sehar Salim
AU - Aamir, Faiqa Binte
AU - Ganny, Hamna
AU - Kazi, Mabrooka
AU - Arshad, Hajra
AU - Raza, Muhammad Abbas
AU - Amin Malik, Muhammad Jawad
AU - Awan, Muhammad Ozair
AU - Sattar, Abida Khalil
AU - Urooba, Amna
AU - Aziz, Aliya Begum
AU - Baig, Erum
AU - Mansoor, Maheen
AU - Inam, Hina
AU - Shah, Mashal
AU - Shamim, Muhammad Shahzad
AU - Siddiqui, Nadeem
AU - Siddiqui, Rehana
AU - Enam, Syed Ather
AU - Ahmed, Warda
AU - Sattar, Abida Khalil
AU - Aziz, Aliya Begum
AU - Shah, Mashal
AU - Shamim, Muhammad Shahzad
AU - Siddiqui, Nadeem
AU - Khan, Sadaf
AU - Noordin, Shahryar
AU - Chawla, Tabish
AU - Enam, Syed Ather
AU - Waqar, Muhammad
AU - Khan, Sara
N1 - Publisher Copyright:
© 2026 The Authors.
PY - 2026/7
Y1 - 2026/7
N2 - Background Surgical site infections (SSIs) are a leading and preventable cause of postoperative morbidity in Pakistan. However, the absence of national-level data has precluded the development of targeted preventative measures. PakSurg1 aimed to quantify the burden of SSIs and evaluate associated risk factors in a multicentre cohort across Pakistan. Methods We conducted a prospective cohort study of 1711 patients across 28 hospitals in Pakistan from 2022 to 2023. Adult patients undergoing elective general or subspecialty surgery were followed for 30 days postoperatively. We assessed SSI incidence and identified risk factors at the patient, surgical, and hospital levels. Findings The overall incidence of SSIs was 9.5% (n = 163). Most SSIs were superficial (73.6%; n = 120) and managed non-surgically with antibiotics (66.9%; n = 109). On multivariable analysis, SSIs were more likely in patients undergoing trauma-related surgery (OR: 3.047 [95% CI: 1.205–7.708]), with contaminated or dirty wounds (OR: 3.245 [95% CI: 1.298–8.113]), or with longer hospital stays (OR: 1.068 [95% CI: 1.036–1.101]). Several modifiable factors were associated with lower odds of SSI. These included laparoscopic surgery (OR: 0.556 [95% CI: 0.343–0.900]), ambulatory procedures (OR: 0.598 [95% CI: 0.375–0.953]), combined chlorhexidine and povidone-iodine skin preparation (OR: 0.304 [95% CI: 0.131–0.704]), and completion of a surgical time-out (OR: 0.446 [95% CI: 0.268–0.743]). Compared to general surgery, lower SSI odds were observed in cardiac (OR: 0.223 [95% CI: 0.074–0.672]), cranio-spinal (OR: 0.292 [95% CI: 0.126–0.676]), and orthopaedic (OR: 0.216 [95% CI: 0.071–0.655]) procedures. Interpretation PakSurg 1 provides a national estimate of SSI incidence in elective surgeries in Pakistan and identifies key, modifiable risk factors. These findings can inform targeted, context-specific strategies to reduce SSIs and improve surgical safety nationwide. Funding This study received monetary funding from the Student & Trainee Initiated Research Program (MBBS Class of ’88 Awards, Aga Khan University, Karachi, Pakistan).
AB - Background Surgical site infections (SSIs) are a leading and preventable cause of postoperative morbidity in Pakistan. However, the absence of national-level data has precluded the development of targeted preventative measures. PakSurg1 aimed to quantify the burden of SSIs and evaluate associated risk factors in a multicentre cohort across Pakistan. Methods We conducted a prospective cohort study of 1711 patients across 28 hospitals in Pakistan from 2022 to 2023. Adult patients undergoing elective general or subspecialty surgery were followed for 30 days postoperatively. We assessed SSI incidence and identified risk factors at the patient, surgical, and hospital levels. Findings The overall incidence of SSIs was 9.5% (n = 163). Most SSIs were superficial (73.6%; n = 120) and managed non-surgically with antibiotics (66.9%; n = 109). On multivariable analysis, SSIs were more likely in patients undergoing trauma-related surgery (OR: 3.047 [95% CI: 1.205–7.708]), with contaminated or dirty wounds (OR: 3.245 [95% CI: 1.298–8.113]), or with longer hospital stays (OR: 1.068 [95% CI: 1.036–1.101]). Several modifiable factors were associated with lower odds of SSI. These included laparoscopic surgery (OR: 0.556 [95% CI: 0.343–0.900]), ambulatory procedures (OR: 0.598 [95% CI: 0.375–0.953]), combined chlorhexidine and povidone-iodine skin preparation (OR: 0.304 [95% CI: 0.131–0.704]), and completion of a surgical time-out (OR: 0.446 [95% CI: 0.268–0.743]). Compared to general surgery, lower SSI odds were observed in cardiac (OR: 0.223 [95% CI: 0.074–0.672]), cranio-spinal (OR: 0.292 [95% CI: 0.126–0.676]), and orthopaedic (OR: 0.216 [95% CI: 0.071–0.655]) procedures. Interpretation PakSurg 1 provides a national estimate of SSI incidence in elective surgeries in Pakistan and identifies key, modifiable risk factors. These findings can inform targeted, context-specific strategies to reduce SSIs and improve surgical safety nationwide. Funding This study received monetary funding from the Student & Trainee Initiated Research Program (MBBS Class of ’88 Awards, Aga Khan University, Karachi, Pakistan).
KW - Disease burden
KW - Incidence
KW - Postoperative complications
KW - Prevention
KW - Risk factors
KW - Surgical site infections
KW - Surgical wound infection
UR - https://www.scopus.com/pages/publications/105040574801
U2 - 10.1016/j.lansea.2026.100786
DO - 10.1016/j.lansea.2026.100786
M3 - Article
AN - SCOPUS:105040574801
SN - 2772-3682
VL - 50
JO - The Lancet Regional Health - Southeast Asia
JF - The Lancet Regional Health - Southeast Asia
M1 - 100786
ER -
SDG 3 Good Health and Well-being