Abstract

Background: Surgical site infections (SSIs) represent a significant global public health challenge, contributing substantially to morbidity, mortality and increased healthcare costs. Effective classification and grading systems are crucial for surveillance, risk stratification and guiding clinical management. The Southampton Wound Grading System offers a standardized approach to categorize postoperative wound complications. Methods: This prospective, observational, analytical study was conducted at a tertiary care teaching hospital in south-western India, involving 1000 consecutive patients undergoing elective surgery at the General surgery unit. Post-operative wound infections were identified and graded according to the Southampton Grading System. Data on SSI incidence and grade distribution were collected. Results: The overall incidence of post-operative wound infections was 12.5% (n=125). A majority of infections were detected on Post-operative Day 7 (52%, n=65), followed by Post-operative Day 3 (27.2%, n=34). According to the Southampton Grading System, Grade I infections were the most prevalent (36%, n=45), followed by Grade II (28%, n=35), Grade III (24%, n=30), Grade IV (9.6%, n=12), and Grade V (2.4%, n=3). Conclusions: The distribution across Southampton grades indicates a predominance of milder infections, yet a notable proportion of severe cases. The Southampton Grading System proved to be a practical and effective tool for categorizing and assessing the severity of SSIs, supporting its utility for clinical surveillance and quality improvement initiatives.

• 1.   Wikipedia. Surgical site infection (https:// en.wikipedia.org/wiki/Surgical_site_infection)
• 2.   Rezaei AR, Zienkiewicz D, Rezaei AR. Surgical site infections: a comprehensive review. J Trauma Inj. 2025;8(2):1360.
• 3.   Edmiston CE, McBain AJ, Roberts C, Leaper D. Clinical and microbiological aspects of biofilmassociated surgical site infections. Adv Exp Med Biol. 2015;830:47-67.
• 4.   Anwar MM, Reizian AE, El Kholy AM, El Sayed I, Hafez MK. An assessment scale for patients with postoperative superficial incisional surgical site infection. J Egypt Public Health Assoc. 2018;93(1):1-7.
• 5.   Rezaei AR, Zienkiewicz D, Rezaei AR. Surgical site infections: a comprehensive review. J Trauma Inj. 2025;8(2):1360.
• 6.   Use of Southampton Scoring for Wound Healing in Post-surgical Patients: Our Experience in Semiurban Setup. Fortune J.
• 7.   Anwar MM, Reizian AE, El Kholy AM, El Sayed I, Hafez MK. An assessment scale for patients with postoperative superficial incisional surgical site infection. J Egypt Public Health Assoc. 2018;93(1):1-7.
• 8.   Momeni A, Lee C, Kim D, et al. A comparative analysis of surgical wound infection methods: predictive values of the CDC, ASEPSIS, and Southampton Scoring Systems in Evaluating Breast Reconstruction Surgical Site Infections. Plast Reconstr Surg Glob Open. 2019;7(5):e2226.
• 9.   Momeni A, Lee C, Kim D, et al. A comparative analysis of surgical wound infection methods: predictive values of the CDC, ASEPSIS, and Southampton Scoring Systems in Evaluating Breast Reconstruction Surgical Site Infections. Plast Reconstr Surg Glob Open. 2019;7(5):e2226.
• 10.   Bailey IS, Karran SE, Parks TG. A study of the aetiology of surgical wound infection. Ann R Coll Surg Engl. 1996;78(5):401-5.
• 11.   World Health Organization. Surgical site infection. World Health Organization; 2014.
• 12.   Rajak R, et al. Incidence and risk factors of surgical site infection in a tertiary care hospital in Nepal: a prospective study. J Nepal Med Assoc. 2024;62(269):1-7.
• 13.   Citizen Surgeon. Wound grading system (Southampton) [Video]. YouTube. 2024.
• 14.   Kulkarni S, et al. Surgical site infections in a tertiary care hospital in Mumbai, India: A prospective study. Indian J Med Microbiol. 2020;38:344-50. doi:10.4103/ijmm.IJMM_20_284.
• 15.   Centers for Disease Control and Prevention. Surgical site infection event (SSI).

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