PakSurg 1: determining the epidemiology and risk factors of surgical site infections in Pakistan-a multicentre, prospective cohort study.

INTRODUCTION: Surgical site infections (SSIs) are among the the most common postoperative complications, despite being highly preventable. Multiple studies have explored the incidence and risk factors of SSIs globally. However, nationally representative data capable of informing evidence-based guidelines remain limited in Pakistan. Hence, the aim of this study is to identify the incidence and risk factors of developing SSIs following surgery and to explore existing SSI prevention practices in Pakistan.

METHODS AND ANALYSIS: This study is a multicentre, prospective cohort study across various sites in Pakistan. All consecutive adult patients undergoing inpatient elective surgery in a 1 month patient recruitment window from one or more of the nine eligible subspecialties will be included in the study. Patients with preoperative infections, emergency surgeries or intraoperative mortality are to be excluded. The following surgical subspecialties are included: breast surgery, cardiac surgery, colorectal surgery, cranial surgery, general surgery, obstetrics and gynaecology, orthopaedics surgery, spine surgery and vascular surgery. Each mini-team of up to three collaborators can select one of the nine subspecialties and a 1 month patient recruitment window from 20 September 2022 to 31 March 2023. Multiple mini-teams from the same sites can recruit patients across the same subspecialty in distinct patient recruitment windows. Additionally, multiple mini-teams from the same sites can recruit patients across different subspecialties in the same or distinct patient recruitment windows. The primary outcome is 30 day SSIs. Secondary outcomes include 30 day antibiotic-resistant SSIs, organ-space infections, other healthcare associated infections, reinterventions and all-cause mortality.

ETHICS AND DISSEMINATION: Approval was received by the Aga Khan University (AKU) Ethics Review Committee (ERC) and the National Bioethics Committee (NBC) Pakistan. The results from this study will be disseminated by the steering committee in journal publications, conference presentations and on other academic platforms. Evidence-based guidelines that result from these data will be disseminated to all surgical care providers in Pakistan through national networks.