Types of Surgery and Risk of Infection
The skin acts as a natural barrier against infection, but even with precautions and protocols to prevent infection in place, any surgery that causes a break in the skin can lead to an infection. These are termed surgical site infections since they occur on the part of the body where the surgery took place. The risk of infection varies based on a number of factors, such as types of surgery.
The chances of developing a surgical site infection remain higher than is desirable, ranging from 1% to 3% 1, and the European Centre for Disease Control estimates that 3.8 million people acquire a healthcare-associated infection annually in acute care hospitals in European Union countries and Norway and Iceland. Meanwhile, an estimated 90,000 people in the European Union die every year as a result of the six most common infections in healthcare contexts 2.
A surgical site infection typically manifests within 30 days of surgery, and the Centers for Disease Control (CDC) describe 3 types of surgical site infections 3. First, a superficial incisional surgical site infection occurs solely in the area of the skin where the incision was made 4. Second, a deep incisional surgical site infection occurs beneath the incision area in the muscles and tissues surrounding these muscles. Third, an organ or space surgical site infection may affect any area of the body other than skin, muscle, and surrounding tissue that was involved in the surgery, including an organ or the space in between organs. Any such infection can result in varying degrees of inflammation, redness, delayed healing, fever, tenderness, pain, warmth, or swelling.
These infections more commonly affect elderly patients, patients undergoing emergency surgeries, and individuals requiring longer preoperative hospital stay and longer surgical duration. They also tend to disproportionately affect patients with a high American Society of Anesthesiology (ASA) index, which categorizes patients based on physical status ahead of anesthesia 5. Consistently, a review identified that risk factors for surgical site infections ranged from reduced fitness and patient frailty to the duration and complexity of surgery 6.
Different types of surgery each carry a particular risk of infection. For example, surgeries that require a longer hospital stay and more invasive types of surgery are linked to a higher risk of infection.
In such cases, a certain number of targeted measures can be taken to minimize the risk of infection. Avoiding razors for hair removal, maintaining normothermia, using chlorhexidine gluconate alongside alcohol–based skin preparation agents, and decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures can all help to suppress the risk of a surgical infection. Furthermore, controlling perioperative glucose concentrations and using negative pressure wound therapy regardless of the type of surgery can also reduce the incidence of surgical site infections.
Another recent study revealed the rate of bloodstream infections was highest after cardiovascular surgery, at 8.7 per 1000 procedures. In contrast, it was lowest after gynecologic surgery, at 1 per 1000 procedures 7. However, trends in the risk of infection across specific types of surgery remain to be confirmed.
While much is known about the risk factors associated with surgical infection, additional research remains to be carried out in order to expand our current knowledge and ensure the lowest possible risk of infection across surgical contexts.
References
1. Surgical Site Infections | Johns Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections. (Accessed: 14th April 2023)
2. HEALTHCARE-ASSOCIATED INFECTIONS. doi:10.1787/9789264266414-en
3. Surgical wound infection – treatment: MedlinePlus Medical Encyclopedia. Available at: https://medlineplus.gov/ency/article/007645.htm. (Accessed: 14th April 2023)
4. Zabaglo, M. & Sharman, T. Postoperative Wound Infection. Clin. Infect. Dis. Second Ed. 729–733 (2022). doi:10.1017/CBO9781139855952.124
5. Ansari, S. et al. Risk Factors Associated with Surgical Site Infections: A Retrospective Report from a Developing Country. Cureus 11, (2019). doi: 10.7759/cureus.4801.
6. Korol, E. et al. A Systematic Review of Risk Factors Associated with Surgical Site Infections among Surgical Patients. PLoS One 8, e83743 (2013). doi: 10.1371/journal.pone.0083743.
7. What type of surgery is linked to highest risk for bloodstream infections? Available at: https://www.beckershospitalreview.com/quality/what-type-of-surgery-is-linked-to-highest-risk-for-bloodstream-infections.html. (Accessed: 14th April 2023)