This international, prospective, multicentre cohort study investigated the global burden of surgical site infection (SSI) after gastrointestinal surgery. 12,539 patients from 343 hospitals in 66 countries were included, stratified into high, middle, and low Human Development Index (HDI) groups. 12.3% of patients developed SSI within 30 days. SSI incidence varied significantly across HDI groups (high: 9.4%, middle: 14.0%, low: 23.2%). After risk adjustment, patients in low-HDI countries had the highest risk of SSI (adjusted odds ratio 1.60). Antibiotic-resistant infections were more prevalent in low-HDI countries (35.9%). The study highlights the disproportionate burden of SSI in low-HDI countries and the need for urgent, pragmatic, randomized trials to address this preventable complication.
