This study presents a large retrospective analysis of more than 130,000 surgical procedures evaluating epidemiological trends, risk factors, and microbiological patterns of surgical site infections (SSI) in a high-complexity referral center in Latin America. The analysis identifies wound contamination class and ASA status as the strongest predictors of infection and highlights the role of long-term institutional surveillance programs in maintaining consistently low SSI rates. These findings provide relevant insights for infection prevention strategies, antimicrobial stewardship, and risk-adjusted surgical quality improvement.