Postoperative wound infections continue to be a major source of morbidity in pediatric surgical practice despite advances in sterilization techniques, perioperative care, and antibiotic stewardship. They contribute to prolonged hospitalization, delayed recovery, and increased treatment costs, making them a persistent clinical concern across diverse healthcare settings [1,2]. Children are particularly vulnerable due to age-related immune immaturity, nutritional fluctuations, and varied underlying conditions that influence postoperative healing responses [3].

The burden of surgical site infections (SSIs) remains significant in low- and middle-income regions where variability in resources, emergency surgical load, and inconsistent adherence to aseptic standards affect infection risk [1–3]. Several studies have documented that the incidence and severity of SSIs in pediatric patients are strongly influenced by wound class, operative duration, urgency of procedure, and presence of comorbid illnesses such as anemia or chronic systemic disorders [4,5]. Emergency procedures and contaminated surgical fields consistently demonstrate higher infection rates because of limited preoperative preparation and greater tissue handling [3–5].

Large multicenter and institutional studies have further emphasized that pediatric wound infections are preventable through structured perioperative practices, early identification of risk factors, and stringent postoperative monitoring [4–6]. Continuous quality audits and institution-specific data play a crucial role in refining infection-control strategies and guiding policy improvements.

Against this background, the present study was undertaken to evaluate the risk factors, incidence, and early clinical outcomes of postoperative wound infections among pediatric surgical patients in a tertiary-care teaching hospital. By analyzing demographic, surgical, and perioperative variables, this study aims to generate updated local evidence that can support enhanced infection-prevention practices and improved patient outcomes.

METHODOLOGY

Study Design and Setting

This hospital-based observational study was conducted in the Department of Pediatric Surgery at RVM Institute of Medical Sciences, Laxmakkapally, Telangana, India. The institute is a tertiary-care teaching hospital providing specialized pediatric surgical services and caters to both rural and semi-urban populations. The study was carried out over a 12-month period from July 2024 to June 2025.

Study Population

All pediatric patients aged 1 month to 18 years who underwent surgical procedures during the study period were eligible for inclusion. Both elective and emergency surgeries were considered. Patients with pre-existing wound infections, immunodeficiency disorders, incomplete postoperative follow-up, or those discharged against medical advice were excluded.

Sample Size

A total of 100 consecutive pediatric surgical patients meeting the inclusion criteria were enrolled. Consecutive sampling ensured representation of routinely operated cases in the department.

Data Collection

Data were collected using a structured proforma and included:

Demographics: age, sex

Surgical variables: type of surgery (elective/emergency), wound class (clean, clean-contaminated, contaminated, dirty), operative duration

Clinical factors: nutritional status, comorbidities, anemia, and antibiotic prophylaxis

Outcomes: postoperative wound status, type of infection (superficial, deep, organ/space), and duration of hospital stay

Postoperative wounds were evaluated daily during hospitalization and at follow-up visits. Wound infections were diagnosed using Centers for Disease Control and Prevention (CDC) criteria.

Operational Definitions

Superficial SSI: involving skin and subcutaneous tissue

Deep SSI: involving deeper soft tissues

Organ/space SSI: involving internal organs or body spaces manipulated during surgery

Prolonged surgery: operative duration >90 minutes

Ethical Considerations

The study was approved by the Institutional Ethics Committee of RVM Institute of Medical Sciences. Written informed consent was obtained from parents or legal guardians, with assent taken from children whenever appropriate.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 25. Descriptive statistics were applied. Categorical variables were expressed as frequencies and percentages, and continuous variables as mean ± standard deviation.

RESULTS

A total of 100 pediatric surgical patients were evaluated during the study period. The demographic characteristics are presented in Table 1. The cohort included 58 boys and 42 girls, with a mean age of 7.2 ± 3.8 years. Elective procedures accounted for 72% of surgeries, while 28% were performed on an emergency basis.

Table 1. Demographic Profile of the Study Population (N = 100)

The surgical characteristics of the study population are summarized in Table 2. Clean and clean-contaminated procedures constituted the majority (81%). Most operations were completed within 90 minutes, with only 22% exceeding this duration.

Table 2. Surgical Characteristics

Figure 1:Surgical Characteristics Distribution

The overall postoperative wound infection rate was 8%, as shown in Table 3. Superficial surgical site infections were most common (6%), and only two patients (2%) developed deep infections. No organ/space infections were identified. Children undergoing emergency procedures experienced higher infection rates (14%) than those undergoing elective surgeries (5%), though all cases were mild to moderate and responded well to standard management.

Table 3. Postoperative Wound Infection Profile

Clinical outcomes are summarized in Table 4. Compliance with perioperative antibiotic prophylaxis was high (96%). An uneventful postoperative recovery was observed in 92% of patients. Among the eight children who developed infections, the mean increase in hospital stay was modest (2.1 days). All patients achieved complete recovery with routine antibiotic therapy and local wound care.

Table 4. Clinical Outcomes and Recovery

Overall, the findings reflect a low burden of postoperative wound infections and highlight effective perioperative practices within the pediatric surgical setting.

DISCUSSION

This observational study demonstrated a low postoperative wound infection rate of 8% among pediatric surgical patients, indicating effective perioperative care and infection-control measures within the institution. Comparable favorable outcomes have been reported in earlier pediatric cohorts, where structured protocols significantly reduced wound-related complications [7,8]. In line with established literature, superficial surgical site infections accounted for most cases in this study, while deep infections remained infrequent and no organ/space infections were observed. Similar trends have been repeatedly documented, highlighting that superficial SSIs continue to predominate due to timely wound assessment and early intervention practices [7,9].

The higher infection rate noted in emergency surgeries compared with elective procedures is consistent with multicenter and institutional findings. Emergency operations often pose challenges such as inadequate preoperative preparation, increased tissue contamination, and higher physiological stress, all of which elevate the risk of SSIs in pediatric and adult populations [8–10]. The present study further demonstrated that contaminated or dirty wounds and prolonged operative duration (>90 minutes) were major contributors to infection risk, supporting evidence that wound class and procedural complexity are important determinants of postoperative infection [9,11].

Nutritional status and comorbidities did not show a significant association with infection outcomes. This is consistent with studies from pediatric surgical centers where optimized perioperative management, nutritional support, and close monitoring have been shown to mitigate infection risk even in medically vulnerable patients [10]. High compliance with antibiotic prophylaxis in this study (96%) also played a crucial role, reaffirming findings that standardized antimicrobial protocols effectively reduce postoperative morbidity [11,12].

The modest increase in hospitalization duration (mean 2.1 days) among infected patients and complete recovery in all cases reflect the benefits of early diagnosis, proper wound management, and structured postoperative follow-up. Previous reports similarly highlight that prompt treatment and adherence to evidence-based wound care guidelines lead to favorable outcomes in pediatric surgical units [10,11].

Overall, this study reinforces the central role of meticulous surgical technique, strict adherence to aseptic protocols, and vigilant postoperative surveillance in minimizing SSIs among pediatric patients. Enhancing preparedness for emergency surgeries and promoting consistent perioperative care pathways may further reduce infection rates, aligning with recommendations from multi-institutional and population-level studies [7–12].

CONCLUSION

This hospital-based observational study demonstrated a low incidence of postoperative wound infections among pediatric surgical patients, highlighting the effectiveness of structured perioperative care at RVM Institute of Medical Sciences. Most infections were superficial, responded promptly to standard management, and resulted in only a minimal extension of hospital stay. Higher infection rates in emergency surgeries underscore the need for strengthened preoperative optimization and adherence to aseptic measures in urgent settings. Consistently high compliance with antibiotic prophylaxis contributed significantly to favourable outcomes. Overall, the findings reinforce the value of meticulous surgical technique, vigilant postoperative monitoring, and standardized clinical protocols in reducing wound-related morbidity in children.

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