Surgical site infection following caesarean section: Incidence and healthcare resource utilisation in a tertiary mother and children hospital in Malaysia

BACKGROUND: Surgical site infections (SSI) is a leading cause of healthcare-associated morbidity and cost globally. However, contemporary data on SSI incidence and economic burden in Malaysia are scarce. This study aimed to estimate the incidence and healthcare costs associated with SSI following caesarean section (C-section) in a Malaysian public hospital. METHODS: A retrospective cohort study was conducted at a tertiary mother and children public hospital in Malaysia, involving patients aged 18 and above who underwent C-section from January 2019 to May 2024. Patients were followed for 30 days postoperatively. Clinical and cost data were obtained from medical records, hospital databases, government gazettes and published literatures. Total direct costs were calculated by matching patient-level resource use with unit cost data. RESULTS: Among 19,736 C-section, 295 SSI were identified, resulting in an incidence of 1.49 per 100 C-sections. Most infections were superficial and observed in emergency C-section. Obesity (49.5%) and diabetes (39.0%) were the commonly observed risk factors. The mean postoperative length of stay was 4.33 days. SSI-related costs totalled RM 714,776 [Ringgit Malaysia (RM) 1 = United States Dollar (USD) 0.23], with procedures and facility-based care being major cost drivers. The mean hospitalization cost per patient was RM 4,178. CONCLUSION: Although the incidence was lower than global estimates, the rising trend and associated healthcare burden highlight the need for enhanced infection prevention strategies such as optimising surgical techniques, strengthening SSI surveillance and implementing evidence-based care bundles. Investing in targeted preventive interventions is essential to improving maternal outcomes and reducing the economic strain on Malaysia's public healthcare system.