Usama Waqar, Shaheer Ahmed, Asad Saulat Fatimi, Warda Ahmed, Russell Seth Martins, Haseeb Waheed, Illiyun Banani, Dahir Ashfaq, Asma Altaf Merchant, Ronika Devi Ukrani, Manzar Abbas, Muskan Abdul Qadir, Izza Tahir, Daniyal Ali Khan, Hareem Rauf, Mahnoor Javaid, Sarim Raheel, Muhammad Uzair, Muhammad Umar Mahar, Sehar Salim Virani, Faiqa Binte Aamir, Hamna Ganny, Mabrooka Kazi, Hajra Arshad, Muhammad Abbas Raza, Muhammad Jawad Amin Malik, Muhammad Ozair Awan, Abida K. Sattar, Amna Urooba, Aliya Begum Aziz, Erum Baig, M Mansoor, Hina Inam, Mashal Shah, Muhammad Shahzad Shamim, Nadeem Siddiqui, Rehana Siddiqui, Sadaf Khan, Shahryar Noordin, Tabish Chawla, Syed Ather Enam, Syed Ather Enam, Usama Waqar, Shaheer Ahmed, Asad Saulat Fatimi, Warda Ahmed, Russell Seth Martins, Haseeb Waheed, Illiyun Banani, Dahir Ashfaq, Asma Altaf Merchant, Ronika Devi Ukrani, Manzar Abbas, Muskan Abdul Qadir, Izza Tahir, Daniyal Ali Khan, Hareem Rauf, Mahnoor Javaid, Sarim Raheel, Muhammad Uzair, Muhammad Umar Mahar, Sehar Salim Virani, Faiqa Binte Aamir, Hamna Ganny, Mabrooka Kazi, Hajra Arshad, Muhammad Abbas Raza, Muhammad Jawad Amin Malik, Muhammad Ozair Awan, Abida K. Sattar, Amna Urooba, Aliya Begum Aziz, Erum Baig, M Mansoor, Hina Inam, Mashal Shah, Muhammad Shahzad Shamim, Nadeem Siddiqui, Rehana Siddiqui, Sadaf Khan, Shahryar Noordin, Tabish Chawla, Syed Ather Enam, Syed Ather Enam, Laiba Kiani, Naeem Ahmed, Shafaq Hanif, Mahnoor Zahra, Amna Aslam, Haasin Iqbal, Zarish Shuja, Huzaifa Shabbir, Umm-e-Roman, Areeba Kabeer, Amerzish Shahid, Aqsa Haider, Fatima Tanveer, Marriam Nazakat, Alveena Waheed, Sana Umer Kiani
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).