Serum Cholesterol Levels as Predictors of Surgical Site Infections in Patients undergoing gastrointestinal Surgery: A prospective Cohort Study

• Intezar Ahmad

  PG Resident, Department of Gneral Surgery, Ananta Institute of Medical Science and research Centre

  Author

• Mukesh Kumar Garg

  Author

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Abstract

Background: Surgical site infections (SSIs) represent one of the most significant complications following gastrointestinal (GI) surgery, contributing to prolonged hospitalization, increased morbidity and mortality, and substantial healthcare costs [1]. While numerous risk factors for SSIs have been identified, including diabetes, obesity, malnutrition, and immunosuppressive medication use, the role of serum cholesterol levels as a modifiable risk factor remains underexplored [2]. Cholesterol plays essential roles in immune function, inflammatory response regulation, and wound healing, suggesting that both hypocholesterolemia and hypercholesterolemia may influence postoperative infection risk [3].

Objective: The primary aim of this prospective cohort study was to evaluate the association between preoperative serum cholesterol levels and the incidence of surgical site infections in patients undergoing elective gastrointestinal surgeries. Secondary objectives included assessing the relationship between cholesterol levels and postoperative complications, prolonged hospitalization, and mortality.

Methods: This prospective cohort study was conducted at a tertiary care center. Adult patients scheduled for elective GI surgery were enrolled consecutively. Preoperative serum total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very-low-density lipoprotein (VLDL) levels were measured. Patients were categorized into hypocholesterolemic (<160 mg/dL), normal (160-200 mg/dL), and hypercholesterolemic (>200 mg/dL) groups based on total cholesterol levels. The primary outcome was the development of SSIs within 30 days postoperatively, diagnosed according to Centers for Disease Control and Prevention (CDC) criteria [4]. Secondary outcomes included length of hospital stay, development of sepsis, organ failure, and 30-day mortality.

Results: A total of 221 patients undergoing elective GI surgery were enrolled. The overall SSI incidence was 28.5% (n=63). Hypocholesterolemia was present in 37.6% (n=83) of patients, normal cholesterol in 43.4% (n=96), and hypercholesterolemia in 18.9% (n=42) of patients. The incidence of SSIs was significantly higher in the hypocholesterolemia group (48.2%, n=40) compared to the normal cholesterol group (18.8%, n=18) and hypercholesterolemia group (11.9%, n=5) (p<0.001). Multivariate logistic regression analysis identified hypocholesterolemia as an independent predictor of SSI (OR 3.51, 95% CI 2.14-5.76, p<0.001) after adjusting for confounders including age, diabetes, BMI, ASA score, operative time, and blood loss. Patients who developed SSIs had significantly longer hospital stays (14.2 ± 6.8 days vs. 7.1 ± 2.3 days, p<0.001) and higher rates of sepsis (19.0% vs. 2.5%, p<0.001).

Conclusion: Preoperative hypocholesterolemia is a significant independent risk factor for the development of surgical site infections following gastrointestinal surgery. Serum cholesterol assessment should be incorporated into preoperative risk stratification protocols, and optimization of low cholesterol levels may represent a novel strategy for SSI prevention.

Copyright (c) 2026 Intezar Ahmad, Mukesh Kumar Garg (Author)

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