Surgical site infection (SSI) remains an important complication of operative care because it can prolong recovery, require antimicrobial treatment or repeat surgery, and increase use of hospital resources. The broad category includes infection confined to skin and subcutaneous tissue as well as deeper incisional involvement. Orthopedic procedures present particular challenges when implants or devitalized tissue are present: bacteria can persist on foreign material, while impaired perfusion can limit tissue defence and antimicrobial penetration. An overview of SSI prevention stresses the combined contributions of host susceptibility, microbial contamination, operative conditions, and prophylactic practices [1]. Evidence-based guidance therefore treats prevention as a sequence of decisions spanning preparation, incision, and postoperative monitoring [2]. Orthopedic populations are heterogeneous. Clean elective operations and surgery after an open injury differ in wound contamination, tissue injury, urgency, and opportunities for preoperative optimization. Consensus terminology for fracture-related infection improves communication about deeper infection following fixation, but the diagnostic framework is distinct from routine 30-day SSI surveillance [3]. Guidance for major extremity trauma emphasizes coordinated wound management and risk reduction, while recommendations for antibiotic prophylaxis stress appropriate agent selection and administration before incision [4,5]. Consistency in definitions and timing is essential when interpreting infection frequency across mixed orthopedic case series. Patient-level factors also deserve attention. Diabetes can be associated with altered neutrophil activity, microvascular dysfunction, and delayed wound healing, although a diagnosis alone does not capture perioperative glycemic control. In a prospective patella fracture cohort, diabetes and longer operations were associated with infection; the wide estimates in small subgroups underline uncertainty around effect size [6]. Recent ankle fixation research likewise distinguishes patient, injury, and treatment characteristics when assessing infection risk [7]. Open fractures introduce environmental contamination and soft-tissue damage, often alongside emergency surgery. These factors can overlap, making a crude association difficult to interpret as an independent effect. Process measures can identify actions within the hospital's control. Timely prophylaxis aims to provide adequate antimicrobial concentration at incision; delays can coincide with emergency workflow or other care constraints. Prevention strategies for orthopedic surgery also include appropriate skin preparation and attention to glycemic management [8]. Nevertheless, observational comparisons cannot isolate the effect of a single practice without detailed information on case mix, injury severity, antibiotic indication, agent, dose, and incision time. Prospective capture of these variables and consistent 30-day follow-up can improve local quality assessment. The objective of this study was to estimate the 30-day proportion of SSI among 100 adults undergoing orthopedic operations at Prathima Institute of Medical Sciences, Nagunur, Karimnagar, during January-July 2026, and to describe unadjusted associations of SSI with diabetes, open fracture, emergency surgery, operative duration greater than 120 minutes, and delayed preincision antibiotic prophylaxis.

Study Design and Setting A prospective observational cohort was described in the Department of Orthopaedics, Prathima Institute of Medical Sciences, Nagunur, Karimnagar, Telangana, India, from January through July 2026. The postoperative surveillance window was 30 days from the index operation and included postdischarge follow-up. Study Population Adults undergoing an eligible index orthopedic operation, including fracture fixation and other elective orthopedic procedures, formed the study population. Only the first eligible operation per person was counted. Inclusion Criteria Adults aged 18 years or older undergoing an orthopedic incision with planned 30-day follow-up were eligible. Emergency and scheduled procedures were included. Exclusion Criteria Patients with an established surgical wound infection before the index procedure, revision for an existing infection, or unavailable 30-day outcome information were excluded according to the described protocol. Sample Size A consecutive sample of 100 eligible patients was included. Sampling and Recruitment The described approach was consecutive recruitment of eligible surgical patients. Clinical Variables and Follow-up Age, sex, diabetes, open-fracture status, urgency, incision and closure times, prophylactic antibiotic administration time, and clinical outcomes were specified for standardized case forms. Delayed prophylaxis was defined as administration after incision or absence of an indicated preincision dose. Culture results were included where recorded. Prophylaxis principles were informed by published guidance [5]. Outcome Measures The primary outcome was a clinically diagnosed superficial or deep incisional SSI within 30 days, classified by the treating team using a prespecified clinical definition based on purulent drainage, an opened incision with signs of infection, or clinician diagnosis. Deep infections after fracture fixation can require separate fracture-related infection assessment under consensus criteria [3,9]. Secondary outcomes were culture positivity, time to diagnosis, debridement, and SSI-related death. Statistical Analysis Counts and percentages summarized categorical variables; age was expressed as mean ± standard deviation, and diagnosis time as median with interquartile range. The SSI proportion was accompanied by a Wilson 95% confidence interval. Unadjusted risk ratios were calculated from exposure-specific two-by-two counts with log-scale Wald 95% confidence intervals; two-sided Fisher exact tests supplied P values. Five comparisons were exploratory without multiplicity adjustment. Ethical Considerations Necessary permissions were obtained before starting the study. No patient identifiers are included in this document.

Participant Characteristics A total of 100 patients were included. Mean age was 46.8 ± 15.2 years and 62 patients were male. Thirty patients had diabetes mellitus, 25 underwent surgery for an open fracture, 35 had emergency operations, 40 had operative duration exceeding 120 minutes, and 20 had delayed antibiotic prophylaxis (Table 1). Table 1. Baseline and perioperative characteristics (N = 100) Characteristic Value Age, years, mean ± SD 46.8 ± 15.2 Male 62 (62.0%) Female 38 (38.0%) Diabetes mellitus 30 (30.0%) Open fracture 25 (25.0%) Emergency procedure 35 (35.0%) Operative duration >120 minutes 40 (40.0%) Delayed antibiotic prophylaxis 20 (20.0%) Values are n (%) unless otherwise stated. SD, standard deviation. Categories other than sex are not mutually exclusive. Delayed prophylaxis indicates administration after incision or absence of an indicated preincision dose. Primary Outcome and Exposure Comparisons SSI occurred in 18 of 100 patients (18.0%; Wilson 95% CI 11.7-26.7%). Diabetes mellitus, open fracture, and delayed antibiotic prophylaxis were associated with higher unadjusted SSI proportions. Emergency surgery and operative duration exceeding 120 minutes also showed higher point estimates, although Fisher exact P values were above 0.05 (Table 2). Table 2. Unadjusted associations with 30-day surgical site infection (N = 100) Factor Exposed: SSI/N (%) Unexposed: SSI/N (%) RR (95% CI) P value Diabetes mellitus 10/30 (33.3%) 8/70 (11.4%) 2.92 (1.28-6.66) 0.020 Open fracture 9/25 (36.0%) 9/75 (12.0%) 3.00 (1.34-6.71) 0.014 Emergency procedure 10/35 (28.6%) 8/65 (12.3%) 2.32 (1.01-5.34) 0.057 Operative duration >120 minutes 11/40 (27.5%) 7/60 (11.7%) 2.36 (1.00-5.57) 0.062 Delayed antibiotic prophylaxis 8/20 (40.0%) 10/80 (12.5%) 3.20 (1.45-7.05) 0.008 SSI, surgical site infection; RR, unadjusted risk ratio; CI, confidence interval; N, exposure-group denominator. Confidence intervals use the log-Wald method; two-sided P values use Fisher exact tests. Comparisons are exploratory and exposures overlap. Infection Characteristics and Secondary Outcomes Fourteen of the 18 infections were superficial and four were deep. Median time to diagnosis was 9 days (interquartile range 6-14). Twelve patients had a positive wound culture; Staphylococcus aureus was the most frequently specified organism. Six patients underwent surgical debridement, and no SSI-related deaths were reported (Table 3). Table 3. Infection characteristics and secondary outcomes among patients with SSI (n = 18) Characteristic Value Superficial incisional SSI 14 (77.8%) Deep incisional SSI 4 (22.2%) Time to diagnosis, days, median (IQR) 9 (6-14) Positive wound culture 12 (66.7%) Staphylococcus aureus 6 (33.3%) Gram-negative organism 4 (22.2%) Other organism 2 (11.1%) Surgical debridement 6 (33.3%) SSI-related death 0 (0.0%) Values are n (%) of 18 patients with SSI unless otherwise specified. SSI, surgical site infection; IQR, interquartile range. Organism categories account for the 12 culture-positive cases.

Among the 100 reported patients, 18 developed a 30-day SSI, including four deep infections. Higher crude proportions occurred among patients with diabetes, open fractures, and delayed prophylaxis. Emergency surgery and operations exceeding two hours showed the same directional pattern, although the exact-test results were less conclusive. The mixed inclusion of emergency and open-fracture cases should be considered when interpreting the overall SSI proportion, which should not be generalized directly to clean elective orthopedic practice. The observed pattern is consistent with several recognized risk domains in orthopedic infection. A prospective cohort of isolated patella fractures reported associations involving diabetes and longer operations [6]. Ankle fracture research has also identified relevant patient- and injury-level predictors [7,10]. Differences in procedure mix, baseline contamination, surveillance duration, and infection criteria can produce substantial variation between studies. In a cohort of more than 1,000 surgically treated ankle fractures, application of a standardized fracture-related infection definition demonstrated how diagnostic criteria influence case ascertainment [11]. Diabetes is an important marker of susceptibility but does not substitute for measured perioperative glucose, vascular status, or nutritional state. Open injury combines greater tissue disruption with exposure to environmental organisms; its association may be confounded by wound severity, urgency, and debridement timing. Longer procedures may reflect complexity, repeated tissue manipulation, or extensive fixation rather than an effect of elapsed time alone. Likewise, apparent risk associated with delayed prophylaxis may partly reflect emergency circumstances and differences in documentation. Existing guidance emphasizes delivery of indicated antibiotics with adequate tissue levels at incision [2,5], while orthopedic prevention reviews support a broader package of perioperative measures [8]. Most infections were superficial. Positive wound cultures were dominated by S. aureus, consistent with the contribution of skin flora to incisional infection, but organism counts in a small sample should not determine empiric antibiotic selection. A deep infection after fixation requires careful assessment under fracture-related infection definitions and appropriate microbiological sampling [3,9]. International recommendations emphasize coordinated surgical and antimicrobial management once such infection is established [12,13]. Diagnostic reviews also distinguish confirmatory evidence of fracture-related infection from nonspecific clinical findings [14]. From a quality-improvement perspective, the results support close attention to antibiotic timing, open-fracture management, glycemic assessment, operative efficiency, and reliable postdischarge surveillance. Future work using individual patient records would permit adjustment for overlapping exposures, injury severity, implant use, smoking, glycemic control, and antibiotic choice. Larger prospective cohorts with standardized infection adjudication would provide narrower estimates and clearer procedure-specific comparisons.

In the reported cohort of 100 adults undergoing orthopedic surgery, the 30-day SSI proportion was 18%, with four deep infections. Diabetes mellitus, open fracture, and delayed antibiotic prophylaxis were associated with higher crude SSI proportions, while emergency surgery and prolonged operations showed less precise differences.

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