This study presents a large retrospective cohort analysis of more than 130,000 surgical procedures evaluating long-term incidence and independent predictors of surgical site infections (SSI) in a high-complexity referral center in Latin America. Multivariable analysis identified wound contamination class and ASA status as the strongest predictors of SSI risk. Findings highlight the impact of structured institutional surveillance programs in maintaining low SSI rates and supporting risk-adjusted infection prevention strategies.