Ssi

1. TO STUDY THE CORRELATION OF
LIPID PROFILE WITH SURGICAL
SITE INFECTION IN ELECTIVE
SURGERY
SUNANDAN SINGLA
JUNIOR RESIDENT
DEPARTMENT OF GENERAL SURGERY
GURU GOBIND SINGH MEDICAL COLLEGE AND
HOSPITAL
FARIDKOT

2. PARTICULARS OF RESPECTED GUIDE AND
CO GUIDE
GUIDE
Dr Amandeep singh
Associate professor
Department of general surgery
CO GUIDE
Dr Heena singla
Associate professor and Head of department
Department of biochemistry

3. AIMS AND OBJECTIVES
• 1. To study serum lipids levels in patient undergoing elective
surgery .
• 2. To study surgical site infection in patients undergoing elective
surgery .
• 3. To correlate serum lipids levels with surgical site infection in
patients undergoing elective surgery.

4. PURPOSE OF STUDY
• Wound complications are major concern for surgeons after surgery. Wound complications divided into early
and late. Early complications include; hematoma, seroma formation, wound dehiscence and burst abdomen.
Late complications include; chronic wound pain, suture sinus and incisional hernias.Surgical Site Infection(SSI)
is the second most common complication.
• Superficial SSI is more common than deep incisional SSI and organ/ space SSI. According to center for disease
control and prevention (CDC) and National Nosocomial infections survellance system (NNIS), Surgical Site
Infections (SSI) are defined as infection occurs within 30 days of an operative procedure with no implant or
within a year if an implant is left in place and infections appears to be related to surgery.
• The SSI rate varies from 2.5% to 41.9% in various studies. The incidence in India (20%) is higher than the other
developed countries like United Kingdom (3.1%) and Netherland (4.3%). On the basis of surgical procedure
incidence of SSI is higher in exploratory laparotomy (34%) followed by colon surgery(21%)
• It has been seen that low total serum cholesterol may contribute to the development of infections in
individuals undergoing surgery. It has been observed that total cholesterol, VLDL, LDL, HDL can protect against
endotoxin mediated sepsis.
• There are studies to prove the correlation between serum lipid levels and surgical site infection in elective
surgery patients.
• Based on these theories the nature of association between serum cholesterol and surgical site complications
is to be evaluated under this study .

5. MATERIALS AND METHODS
Study setting
• This study will be conducted in the Department of General Surgery, Guru Gobind Singh Medical College & Hospital Faridkot after approval from institutional ethical
committee.
Study period
• 18 months
Study design
• Prospective study.
Study population
• All the patients presented to outpatient and admitted under the department of surgery department undergoing elective surgeries .
Sample size
• n=150.

6. INCLUSION CRITERIA
• Patients of either sex.
• Age 18-60 years.
• Patients giving consent for elective surgery.

7. EXCLUSION CRITERIA
• Patients with age less than 18 years and more than 60 years.
• Patients with steroid use and immunodeficiency.
• Patients undergoing emergency surgeries
• Patients with h/o smoking, alcoholics.
• Patients with hypoalbuminaemia.
• Patients unfit for surgery.
• Patients with liver cirrhosis.
• Patients with anaemia

8. MATERIALS AND METHODS
Sampling Technique
• Keeping in view of the availability and feasibility of the participants, a
non-random convenient sampling technique will be adopted. So,
consecutively 150 eligible participants will be considered for the
study.
Data Collection Tools
• The data will be collected using a pre-designed structured proforma
eliciting information regarding socio-demographic and other clinical
variables. (Performa attached with the plan)

9. METHODOLOGY
• All the patients were worked up and assessed according to following principles:
1) Detailed history .
2) Complete clinical examination.
3) Complete routine investigations.
4) ) Blood sample of patient in plain vial containing 2 ml of blood in early morning 1 day before surgery in fasting state is to be send for lipid profile
which will be done by fully automated chemical analyser and following values will be considered normal as below..
Total cholesterol – 125 - 225 mg/dL
HDL cholesterol: 30 -70 mg/dL
LDL cholesterol: 85 – 140 mg/dL
Triglycerides: 50 -160 mg/dL
VLDL cholesterol : 7 – 35 mg/dl
Pre operative:
• Shaving will be done at the operative area.
• All patients are given Inj Amoxicillin and clavulanic acid iv stat 1 hour before surgery.
• Surgical site will be cleaned with spirit and 10% Povidone iodine sol.
• All the patients are explained about the procedure.

10. Intra Operative:
• Incision site will be cleaned with betadine 10% solution thrice.
• After completion of surgery surgical site will be closed in layers.
• Antiseptic dressing will be done.
Post Operative:
• Daily wound examination will be done for any discharge or redness or other signs of inflammation.
• Daily Antiseptic dressing will be done after cleaning the wound with normal saline solution.
Diagnosis of SSI will be made according to the Centers for Disease Control and Prevention’s (CDC) definition,
includes criteria:
• a) Purulent drainage, with or without laboratory confirmation.
• b) Organisms isolated from an aseptically obtained culture of fluid or tissue.
• c) At least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness or heat, which
require the superficial incision to be deliberately opened by a surgeon, unless the incision is culture negative.
• d) Diagnosis of superficial SSIs made by a surgeon or attending physician.
Further according to definition, patient will be followed up for 30 days for any SSI and other complications.
• The data will be collected and segregated to find the incidence of SSI in both the groups and comparison will be done to
Evaluate the the role of serum cholesterol and various lipids in developing surgical site infection.
Data analysis plan
• After completion of the study, observations obtained will be tabulated, analyzed and evaluated using statistical methods.
Appropriate statistical techniques will be used to compare the two groups. Data will be described by using means and standard
deviation

11. REFERENCES
1. Magill SS. Changes in prevalence of health care-associated infection in U.S. hospitals .NEJM. 2018;
379(18): 1732-1744 .
2. Setty NKH, Nagaraja MS, Nagappa DH, Giriyaiah CS, Gowda NR, Naik RM. A study on Surgical Site
Infections(SSI) and associated factors in a government tertiary care teaching hospital in Mysor,
Karnataka. IJMEDPH. 2014;4(2):171-75.
3.Cooper RA. Surgical site infections: epidemiology and microbiological aspects in trauma and
orthopaedic surgery. Int Wound J. 2013;10(1):3-8.
4 Manivannan R , Prasad SR. Role of serum cholesterol and statin usage in predicting nosocomial
surgical site infections after gastrointestinal surgery. JDMS.2019 ; 22790861(18)05-09.
5. Morimoto M , Nakamura Y, Atsuko S , Nagaie T, Shirabe K. Serum total cholesterol levels would
predict nosocomial infections after gastrointestinal Surgery IJS.2015; 77(4): 283–289.
6. Rodríguez MD , Cuadros MM, Gallego GM, Arenas MS .Total cholesterol, HDL-cholesterol, and risk
of nosocomial infection: a prospective study in surgical patients. ICHE .2018;18(1):9-18.
7. Lagrost L , Girard C, Grosjean S, Masson D, Deckert V, Gautier T et al . Low preoperative
cholesterol level is a risk factor of sepsis and poor clinical outcome in patients undergoing cardiac
surgery with cardiopulmonary bypass. Crit care med. 2014 ;42(5):1065-73.