Evaluation of Serum Cholesterol Level as a Risk Factor for Developing Surgical Site Infections following Clean Elective Surgery: A Prospective Cohort Study

Introduction: Surgical Site Infection (SSI) is defined as an infection occurring in an incisional wound within 30 days of the procedure or within one year if a prosthesis is implanted. SSIs increase hospital stays, expenditures, morbidity and significantly impact patients’ mental wellbeing, causing anxiety, stress and potential emotional distress. A multitude of patientrelated, surgical and physiological variables contributes to the heightened risk of developing SSIs. Addressing patientrelated risk factors for SSIs involves proactive measures such as optimising preoperative health, managing blood sugar and albumin levels and promoting healthy lifestyle choices such as smoking cessation. Aim: To evaluate serum cholesterol levels as a risk factor for developing SSI. Materials and Methods: A prospective cohort study was conducted at a tertiary healthcare centre from January 1st, 2023, to December 31st, 2023. It included 107 patients undergoing clean elective surgery. The relation of preoperative and postoperative serum cholesterol levels, serum High-Density Lipoproteins (HDL), serum Low-Density Lipoproteins (LDL), serum Very Low-Density Lipoproteins (VLDL) and serum triglycerides to SSI was studied. The data were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0 and the Student’s t-test was employed to obtain the results. Results: Out of 107 cases, SSI was observed in 23 patients (21.5%). Among these cases, there were 54 males and 53 females, with a mean age of 43.50±16.29 years. This study concluded that deranged HDL was associated with 65.22% of cases with SSI (p-value <0.001). Regarding preoperative cholesterol levels, 86.96% of patients without SSI had normal cholesterol, compared to 82.14% in those with SSI (p-value=0.585). For postoperative cholesterol levels, 91.3% of patients without SSI had normal cholesterol, versus 89.29% in those with SSI (p-value=0.778). Conclusion: The association of preoperative and postoperative serum cholesterol levels in the development of SSI could not be established in this study. However, serum HDL emerged as a good prognostic indicator for SSI after clean elective surgery. It should be checked and optimised in all cases prior to surgery.