{"paper_id":"a6dae54e-8e7c-424e-9401-cc2962c15a3b","body_text":"~ 794 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2026; 10(3): 794-798 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \nIndexing: Embase \nImpact Factor (RJIF): 6.71 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2026; 10(3): 794-798 \nReceived: 12-02-2026 \nAccepted: 14-03-2026 \n \nMahima Rani \nAssociate Professor, Department of \nObstetrics & Gynaecology, \nGovernment Medical College, \nHaldwani, Uttarakhand, India \n \nRichi Singh Solanki \nSenior Consultant, Department of \nObstetrics & Gynaecology, KVR \nHospital, Kashipur, Uttarakhand, \nIndia \n \nRicha Kumari \nPrivate Practitioner, Department \nof Obstetrics & Gynaecology, \nUttarakhand, India \n \nKamal \nMedical Officer, Department of \nObstetrics & Gynaecology, \nUttarakhand, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nKamal \nMedical Officer, Department of \nObstetrics & Gynaecology, \nUttarakhand, India \n \nStudy of surgical site infection and it's associated factors \namong female undergoing hysterectomy in tertiary \nhospital of Kumaon Region \n \nMahima Rani, Richi Singh Solanki, Richa Kumari and Kamal \n \nDOI: https://www.doi.org/10.33545/gynae.2026.v10.i3k.2348  \n \nAbstract \nBackground: Surgical site infections (SSIs) are infections that arise within 30 days following surgery, or \nup to one year if an implant is left remaining after the procedure. These infections specifically attack either \nthe surgical wound or deep tissue at the site of the operation.  \nObjective: estimating the rate of surgical site infections (SSIs) and identifying their associ ated factors \namong females undergoing hysterectomy at a tertiary hospital in the Kumaon region.  \nMethods: All participants were included in the study after providing informed written consent. The study \nmeticulously collected and analyzed data from these participants, focusing on their demographic details, \nsurgical details, and post -operative outcomes, particu larly the development of surgical site infections. \nResult: The majority of the participants fell into the middle -age bracket, with significant numbers dealing \nwith conditions like fibroids , adenomyosis, endometriosis and ovarian cysts, highlighting the bur den of \ngynecological issues leading to surgical interventions. The study identified an SSI occurrence rate of 17%. \nEscherichia coli emerged as the predominant pathogen responsible for SSIs, exhibiting substantial \nresistance to antibiotics like Ciprofloxaci n. Key risk factors for developing SSIs were notably linked to \nolder age and higher body mass index (BMI).  \nConclusion: The findings of this study highlight a significant association between anemia, diabetes, and \nthe increased prevalence of surgical site i nfections (SSI). Both anemia and diabetes contribute to impaired \nimmune function and delayed wound healing, making individuals with these conditions more susceptible to \npostoperative infections. Proactive strategies, including optimizing blood glucose levels in diabetic patients \nand addressing anemia before surgery, could play a crucial role in improving surgical outcomes and \nreducing healthcare costs associated with SSIs. \n \nKeywords: Surgical Site Infection, Hysterectomy, anemia, diabetes \n \nIntroduction  \nSurgical site infection (SSI) continues to be a prevalent and widespread issue that leads to \nconsiderable illness and death, extends the duration of hospital stays, and ultimately raises \nhealthcare expenses. SSIs are more likely to occur in patients with longer hospital stays, obesity, \ndiabetes mellitus, smoking, and other related factors. The occurrence of a postpartum wound \ninfection is contingent upon the intricate interaction of several elements. The primary cause of \ninfection in the majority of postop erative wounds is endogenous. Exogenous infections \nprimarily originate from the nasal or skin bacteria present in the operating team and are spread \nthrough the surgeon's hands or inadequate sterilization of the operating theatre. This includes the \ncare provided before, during, and after the surgery [1]. Several crucial elements that can impact \nthe likelihood of a subsequent infection include surgical procedures, skin preparation, timing, \nthe style of wound closure, and the use of antibiotics to prevent infe ction following specific \ntypes of surgery. In addition, numerous other variables have been recognised as  influencing the \nlikelihood of infection, and healthcare practitioners should take them into account prior to, \nduring, and following surgical procedures [2]. Surgical site infections (SSIs) were infections that \noccur at or around the surgical incision between 30 days of the procedure, or up to 1 year if an \nimplant is inserted [3]. The Centre for Disease Control and Prevention (CDC) classifies surgical \nsite infections into two categories: incision infections (superficial and deep) and organ space \ninfections (affecting any part of the anatomy) [4]. These infections must develop within 30 days \nof the operation and are categorised based on the cleanliness of th e operative wounds: clean, \nclean-contaminated, contaminated, and dirty wounds [5, 6]. \nSurgical site infection poses a significant threat to patients and results in financial losses for \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 795 ~ \nhealth systems due to its complex causes. Achieving a \nquantitative and persistent reduction in the risk of surgical site \ninfection is tough. \nIn the past 20 y ears, significant progress has been achieved in \nthe selection of methods for performing hysterectomies. While \nthere have been reports on the occurrence and risk factors of \nsurgical site infections (SSI) after total abdominal hysterectomy \n(TAH), there is cu rrently no available information on the \noccurrence or risk factors of post - hysterectomy SSI based on \nthe specific method of hysterectomy [7,. 8, 9]. Enhanced \ncomprehension of the risk variables associated with surgical site \ninfections (SSI) following hystere ctomy can facilitate the \nfocused allocation of resources towards mitigating modifiable \nrisks, hence preventing infections [10]. Moreover, gaining \nknowledge about the risk factors for surgical site infections \n(SSI) following a hysterectomy might result in i mproved \ncategorization of risk levels when reporting the quality of \noutcomes. The aim of our study is to determine the frequency of \nsurgical site infections (SSI) within 30 days after different types \nof hysterectomy procedures, and to identify any characte ristics \nthat may be related with an increased risk of SSI. \n \nMaterial and Methods \nA Prospective Cohort study was conducted among all women \nundergoing hysterectomy during study duration who fulfills \ninclusion criteria in Obs & Gynae Department of Dr. Sushila  \nTiwari hospital, Haldwani. Duration of study was 18 months \nafter approval of IEC whichever is early. \n \nInclusion criteria \n All patient willing to participate. \n All cases undergoing hysterectomy  (elective/emergency) in \nDr Sushila Tiwari Hospital Haldwani. \n \nExclusion criteria \n All patients who do not want to participate. \n Hysterectomy done outside Dr . Sushila Tiwari Hospital \nHaldwani. \n \nSampling method \nConsecutive sampling \n \nPlan of study \nAll women who underwent hysterectomy in the Obs &  Gynae \nDepartment of Dr. Sushila Tiwari Hospital, Haldwani, and who \nfulfilled the inclusion criteria, were included in the study after \ntaking informed written consent. Participants were followed up \nfor a maximum period of 30 days to check for the developme nt \nof signs of wound sepsis, such as wound discharge, wound \ninduration, wound edema, and wound gaping. \n All participants' socio -demographic details, along with the \npresence of risk factors, were taken using a pre -tested \nschedule. \n If a participant developed signs of sepsis as mentioned \nabove, culture and antibiotic sensitivity testing were \nperformed to identify the infection-causing organism as well \nas the antimicrobial resistance pattern. \n \nStudy tools \nA pre -tested schedule was used to record socio - demographic \ndetails along with risk factors, culture and antibiotic sensitivity. \n \nStatistical analysis \nThe data was compiled in MS Excel, and the analysis was done \nusing appropriate statistical tests with SPSS version 16. \n \nResults \nFor age, the participants are categorized into three groups: those \nunder 30 years old (1 participant, 1.0% of the total), those aged \nbetween 30 and 49 years (60 participants, 60.0%), and those \nover 49 years old (39 participants, 3 9.0%). The mean age of the \nparticipants is 47.2 years, with a standard deviation of 7.72 . \nSocioeconomic Status is classified into three categories: High, \nMiddle, and Low. Among the participants, 19% are categorized \nas High SES (19 participants), 34.0% as M iddle SES (34 \nparticipants), and 47.0% as Low SES (47  participants). BMI \n(Body Mass Index) reveals that 34% of participants (34  \nindividuals) are classified as Overweight, with a mean BMI of \n29.1 and a standard deviation of 1.67.  \n \n \n \nFig 1: Genecological history of study participants \n \nFibroids are reported in 41 participants, constituting 41% of the sample. Prolapse is high prevalence, reported by 30 participants, \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 796 ~ \nmaking up 30% of the sample.  Endometriosis and Adenomyosis \ntogether accounts for 27 participants, accounting for 27% of the \ntotal samp le. Ovarian Cysts are noted in 2 participants, also \nmaking up 2% of the participants. None of the specified \ngynecological conditions, indicating a subgroup within the study \npopulation that is free from these particular health issues. \n \nTable 1: Past History of study participants (n =100) \n \nPast History Frequency Percentage \nDiabetes 12 12% \nAnemia 22 22% \nHypertension 15 15% \n \nThe table 1 presents the past medical history of study \nparticipants, detailing the prevalence of three specific \nconditions: Diabetes ( 12%), Anemia ( 22%), and Hypertension \n(15%). \nFor Type of Anesthesia, the majority underwent spinal \nanesthesia (60.0%), followed by General anesthesia (27.0%) and \nepidural anesthesia (13.0%). Type of Incision was \npredominantly Pfannenstiel in 54.0% of cases, with midline \nincisions in 16.0%. Type of suture with Vicryl used in 100% of \ncases. The  mean duration of surgery  was 105  minutes, with  a \nstandard deviation of 23.7 minutes, indicating the average time \ntaken for the procedures performed. \n \nTable 2: Post operative complications seen in study participants \n(n=100) \n \nPost-op Complications Frequency Percentage \nUTI 12 12% \nDVT 0 0% \nWound Dehiscence 2 02% \nWound Infection 15 15% \nNone 79 79% \n \nThe table 2 summarizes post -operative complications observed \nfollowing hysterectomy procedures among study participants. \nThe most prevalent complication is urinary tract infection (UTI), \nreported in 12 participants (12.0%), followed by wound \ninfection and wound dehiscence, each noted in 15% and 02% of \nparticipants respectively. A majority of participants, 79%, did \nnot experience any post-operative complications. \n \nTable 3: Development of SSI seen in study participants (n=100) \n \nSSI development Frequency Percentage \nYes 17 17.0 \nNo 83 83.0 \n \nThe table 3 presents data on the development of Surgical Site \nInfections (SSI) following hysterectomy procedures among \nstudy participants. Out of the total, 17 participants (17.0%) \nexperienced SSI, while the majority, 83 participants (83.0%), did \nnot encounter such infections post-operatively. \nAmong those who developed SSI, Escherichia coli ( E. coli) was \nthe most frequently identified pathogen, present in 9 cases \n(53.0%). Methicillin -resistant Staphylococcus aureus  (MRSA) \nand Staphylococcus aureu s were each identified in 4 cases, \naccounting for 23.5% each. \nAmong the pathogens, 53.0% were resistant to Ciprofloxacin. \nAdditionally, 23.5% were resistant to methicillin but sensitive to \nVancomycin, while the same percentage (11.75%) showed \nresistance to Penicillin but were sensitive to Vancomycin. \nAnother 11.75% w ere resistant to methicillin without reference \nto their sensitivity to other antibiotics. \nThe distribution across age groups shows significant differences \nin the incidence of SSI (Chi square = 16.2, p = 0.0003). \nParticipants over 49 years old had the highe st incidence of SSI \n(14 cases), followed by those aged 30 -49 years (3 cases). The \nage group under 30 years had no reported cases of SSI. There \nwere no significant differences in SSI incidence across \nsocioeconomic statuses (Chi square = 0.38, p = 0.8274). S SI \ncases were relatively evenly distributed among participants \nclassified as High (4 cases), Middle (6 cases), and Low (7 cases) \nsocioeconomic status. Significant differences were observed in \nSSI incidence based on BMI categories (Chi square = 6.84, p < \n0.0089). Participants classified as Obese had a notably higher \nincidence of SSI (12 cases) compared to those classified as \nOverweight (5 cases).  \n \nTable 4: Association of SSI with Gynecological History of study \nparticipants \n \nGynecological \nHistory SSI SSI Percentage Statistics \nEndometriosis 1 33% \nChi square: 11.4 \np value: 0.161 \nAdenomyosis 6 25% \nFibroids 7 17% \nOvarian Cysts 1 50% \nProlapse 2 6.6% \nEndometrial cancer 0 0% \n \nThe table 4 presents the association between gynecological \nhistory and the occurrence of Surgical Site Infections (SSI) \namong study participants, along  with the corresponding \nstatistical tests. The distribution across gynecological history \ndoes not show any significant differences in the incidence of SSI \n(Chi square = 11.4, p = 0.161). \n \nTable 5: Association of SSI with Past History of study participants \n \nPast History SSI No SSI Statistics \nDiabetes 05 07 Chi square: 2.58 \np value: 0.03 \nAnemia 7 15 Chi square-11.1 \np value: 0.002 \nHypertension 02 13 Chi square: 1.5 p \nvalue: 0.22 \n \nThe table 5 presents the relationship between past medical \nhistory variables and the occurrence of Surgical Site Infections \n(SSI) following hysterectomy procedures, along with associated \nstatistical tests. There is statistically significant association \nfound between Diabetes and SSI (Chi square = 2.58, p = 0.03). \nFive cases of SSI were reported among those with Diabetes, \nwhile 07 cases were reported among those without. There is \nstatistically significant association found between Anemia and \nSSI (Chi square = 11.1, p = 0.002). Seven cases of SSI were \nreported among those with Anemia, while 15 cases were \nreported among those without. There is a no statistically \nsignificant association between Hypertension and SSI (Chi \nsquare = 1.5, p =  0.22). Two cases of SSI were reported among \nthose with Hypertension. \n \nDiscussion \nIn our study, we explored demographic and health -related \ncharacteristics of 100 participants, summarizing the findings in \nterms of frequencies, percentages, and mean values along with \nstandard deviations where applicable. The age distribution \namong the participants revealed a skewed older age group, with \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 797 ~ \nonly 1% (1 participant) under the age of 30 years, and the \nmajority falling within the 30 -49 years (60%) and over 49 years \n(39%) categories. The overall average age was 47.2 years, \nindicating a middle - aged cohort with a standard deviation of \n7.72, which suggests a relatively tight age range among \nparticipants. Which is in consistent with study findings S. Latha, \net al. study conducted in India found that women aged 55 and \nolder had a higher rate of SSIs aft er hysterectomy, emphasizing \nthe role of age and chronic conditions like diabetes in increasing \ninfection risk. \nSocio-economic status (SES) was divided into three categories: \nHigh, Middle, and Low. The distribution was fairly even across \nthese categories, with 19% of participants classified as having \nHigh SES, 34% as Middle SES, and 47% as Low SES. This \ndiverse socioeconomic representation helps in understanding the \ninfluence of economic conditions on the health outcomes being \nstudied. \nRegarding Body Mass Index (BMI), a significant portion of the \nstudy population was categorised as overweight (34%)  with a \nmean BMI of 29.1 and a standard deviation of 1.67. The \nremaining 24% were categorized as obese. This high prevalence \nof overweight and obese participants is critical, as it underscores \nthe potential health challenges in this demographic, which could \ninclude a higher risk of surgical site infection. This is in \nconsistent with other study findings like study by Olsen MA, et \nal specifically looked at the increased risk of SSIs in obese \npatients undergoing abdominal surgery, finding that obesity was \nan independent risk factor, especially for deep and organ/space \ninfections. Kudachi SS, Bhandare SD, Kumar A et al . study \nassessed the impact of obesity on SSI rates following abdominal \nsurgeries. It found that obese patients had a higher rate of \npostoperative infections compared to non -obese patients, largely \ndue to prolonged operative time and wound healing issues. \nOur study involving 100 participants highlights significant \nfindings regarding the gynecological history and conditions \nleading to hysterectomy  among women. An examination of the \ngynecological history shows a notable prevalence of fibroids \n(41%), the highest among surveyed cond itions, affecting nearly \nmore than one third of the participants. \nSimilarly, both endometriosis and adenomyosis together affect \n27%of the sample, suggesting a commonality in the incidence of \nthese conditions, which are often associated with significant \nmorbidity which is in consistent with findings of Choi EJ et al, \nthe analysis of 61,516 patient records over a three -year period, \nthe prevalence of adenomyosis was found to be 12.4% in 2009, \nincreased slightly to 12.5% in 2010, and then to 13.3% in 2011. \n(11). For endometriosis, the prevalence rates were 9.3% in 2009, \n9.4% in 2010, and decreased to 9.1% in 2011. Prolapse are also \nprevalent in 30% of the participants, further emphasizing the \nfrequency of these gynecologic issues in our study population. \nInterestingly, ovarian cyst is relatively less common, reported by \nonly 2% of the participants. \nRegarding the past medical history, a substantial number of \nparticipants report chronic conditions such as diabetes 12%, \nanemia 22%, and hypertension 15%. These conditions may \ncontribute to or complicate gynecological issues, underlining the \nimportance of managing these chronic diseases alongside \ngynecological care. In our study prevalence of SSI was highest \nin medical conditions like anemia and diabetes, that is around \n31% and 41%.Both Indian and international studies support the \nassociation between anemia  and increased SSI risk in \nhysterectomy patients. \nMiller et al . (2013) identified preoperative anemia as a \nsignificant risk factor for SSIs in gynecologic surgeries. \nMukherjee et al . (2019) in India highlight that moderate to \nsevere anemia (hemoglobin <10 g/dL) is associated with a \nnotably higher risk of infection compared to mild anemia. In our \nstudy assessing the intra -operative variables of 100 participants \nundergoing hysterectomy, we observed a predominant \npreference for spinal anesthesia, which was use d in 60% of \ncases. This was followed by General anesthesia at 27% and \nepidural anesthesia at 13%. \nRegarding the type of incision made during the surgery, \nPfannenstiel incisions were more common, used in 54% of \ncases, compared to midline incisions which were utilized in 16% \nof cases. This could suggest a preference for Pfannenstiel \nincisions due to factors like reduced post -operative pain and \nbetter cosmetic outcomes, which align with existing literature. \nThe selection of sutures varied, with Vicryl being th e most \nfrequently used (100%). The average duration of the surgeries \nwas 105 minutes, with a standard deviation of 23.7 minutes, \nindicating a moderate variability in the length of these \nprocedures which could be influenced by factors such as the \ncomplexity of the case and surgeon experience. \n Post-operatively, the majority of our participants (69%) did \nnot experience any complications, which highlights the \nefficacy of the surgical and management protocols in place. \nHowever, urinary tract infections were the most reported \ncomplication, affecting  12% of the participants. Wound \ninfection and wound dehiscence each occurred in 17% of \nthe cases, necessitating consideration for enhanced \nprophylactic measures and post -operative care.  The very \nlow incidence of wound dehiscence (2%) suggests effective \nsterility and antibiotic protocols during and after surgery. In \nour study, we  observed the development of Surgical Site \nInfections (SSIs) in a cohort of 100 individuals who \nunderwent hysterectomy procedures. The data revealed that \n17% (n=17) of the partici pants developed SSIs, while the \nvast majority, 83% (n=83), did not experience any \npostoperative infections. Escherichia coli ( E. coli ) was the \nmost frequently encountered pathogen, found in 53% of the \nSSI cases.  Methicillin-resistant Staphylococcus aureus  \n(MRSA) and Staphylococcus aureus  were identified in \n23.5% of cases each. This distribution is noteworthy as it \nhighlights the common bacterial agents responsible for post-\nsurgical complications and underlines the importance of \ntargeted antibiotic prophylax is. Regarding antibiotic \nresistance, 53% of the pathogens were resistant to \nCiprofloxacin, which poses a challenge for treatment. \n In our study prevalence of SSI was much more in \nabdominal hysterectomy as compared to vaginal \nhysterectomy which is in consist ent with other studies such \nas those by Wright et al . (2011) and Miller et a l. (2013) \nhave consistently shown higher SSI rates in abdominal \nhysterectomies compared to vaginal or laparoscopic \nprocedures. This trend holds true within India, as seen in \nstudies like Mukherjee et al . (2019), which report higher \ninfection rates in abdominal hysterectomies. \n \nConclusion \nThe findings of this study highlight a significant association \nbetween anemia, diabetes, and the increased prevalence of \nsurgical site infections (SSI). Both anemia and diabetes \ncontribute to impaired immune function and delayed wound \nhealing, making indi viduals with these conditions more \nsusceptible to postoperative infections. This underscores the \nneed for preoperative screening and management of these risk \nfactors to reduce SSI incidence. Proactive strategies, including \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 798 ~ \noptimizing blood glucose levels i n diabetic patients and \naddressing anemia before surgery, could play a crucial role in \nimproving surgical outcomes and reducing healthcare costs \nassociated with SSIs. \n \nConflict of Interest \nNot available  \n \nFinancial Support  \nNot available \n \nReferences: \n1. Chang DT, Lee AJ. The economics of surgical site \ninfections in healthcare settings. Health Economics. \n2019;28(8):1031–1042. \n2. Singh R, Patel H. Postoperative care and the incidence of \nsurgical site infections. Journal of Postoperative \nManagement. 2023;5(2):112–123. \n3. Moore J, Thompson C. The effectiveness of prophylactic \nantibiotics in surgery. 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Profile of wound infection following caesarean \nsection delivery at Institute of Child & Mother Health, \nMatuail, Dhaka [dissertation]. Dhaka: Bangladesh College \nof Physicians and Surgeons; 2011. \n11. Choi EJ, Cho SB, Lee SR, Lim YM, Jeong K, Moon HS, et \nal. Comorbidity of gynecological and non -gynecological \ndiseases with adenomyosis and endometriosis. Obstet \nGynecol Sci. 2017;60(6):579 –586. \ndoi:10.5468/ogs.2017.60.6.579. \n \n \nHow to Cite This Article \nRani M, Solanki RS, Kumari R, Kamal. Study of surgical site infection and \nit's associated factors among female undergoing hysterectomy in tertiary \nhospital of Kumaon Region . International Journal of Clinical Obstetrics \nand Gynaecology. 2026;10(3):794-798.  \n \n \nCreative Commons (CC) License \nThis is an open access journal, and articles are distributed under the terms \nof the Creative Commons Attribution -Non-Commercial-Share Alike 4.0 \nInternational (CC BY -NC-SA 4.0) License, which allows others to  remix, \ntweak, and build upon the work non -commercially, as long as appropriate \ncredit is given and the new creations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}