Pandemic Shadows in the Operating Room: How COVID-19 Altered the Risk and Timing of Surgical Site Infections: A Multivariable Risk Assessment and Time-to-Event Analysis in a Cohort of Abdominal Surgery Patients

Background Surgical site infections (SSIs) are common but preventable complications of abdominal surgery, influenced by patient, procedural, and systemic factors. The COVID-19 pandemic introduced new perioperative protocols that may have altered infection patterns. This is the first retrospective cohort study of 809 abdominal surgery patients from a large tertiary center in Saudi Arabia to assess changes in SSI timing using survival analysis during the pandemic. Objectives To determine SSI incidence, identify independent risk factors, and examine the impact of the COVID-19 pandemic on infection timing and outcomes in patients undergoing abdominal surgery. Methods We conducted a retrospective cohort study of 809 patients who underwent abdominal surgery between January 2019 and December 2022. Data on demographics, comorbidities, surgical characteristics, and outcomes were extracted from electronic health records. SSIs were defined per CDC criteria. We compared SSI trends before and during the pandemic using multivariable logistic regression and time-to-event analyses (Kaplan-Meier and Cox regression). Results Among 809 patients, 47 (5.8%) developed SSIs—consistent with international benchmarks. Independent risk factors included diabetes (OR: 2.14; 95% CI: 1.05–4.34), contaminated wounds (OR: 3.67; 95% CI: 1.58–8.54), and postoperative glucose ≥ 7 mmol/L (OR: 2.95; 95% CI: 1.32–6.57). SSIs occurred later during the pandemic period, with survival analysis indicating delayed onset, despite a similar median time (8 days). Model diagnostics confirmed stability, with no significant multicollinearity. Conclusion SSIs remain a significant postoperative risk, with diabetes, wound contamination, and hyperglycemia as key predictors. The observed delay in infection onset during the COVID-19 pandemic underscores the need for extended postoperative surveillance and adaptable infection control strategies during healthcare disruptions. These findings suggest that pandemic-related changes in surgical protocols may delay SSI onset, necessitating extended postoperative monitoring.